Active offset-frequency control of optical frequency comb via sum-frequency mixing of passively mode-locked laser and continuous-wave laser.

We propose a method for actively controlling the frequency of an optical frequency comb (OFC) using sum-frequency generation (SFG) with a nonlinear crystal. For the first time, OFC generation was experimentally demonstrated via sum-frequency mixing of a narrowband continuous wave (CW) laser and a passively mode-locked fiber laser. By adjusting the optical frequency of the CW laser, we successfully controlled the offset-frequency of the SFG-OFC, which was mapped from the OFC of the pulse pump laser. Furthermore, by comparing the spectral widths of the SFG-OFC modes generated from two CW lasers with different spectral widths, we confirmed that the spectral characteristics of the SFG-OFC modes depended on the spectral features of the CW laser.

A novel approach to identify priority areas for optimal nutrient management in mixed land-use watersheds through nutrient budget assessment.

Excessive nutrient supply in agricultural regions has led to various environmental issues, thereby requiring concentrated management owing to its persistent upward trend. Nutrient budgets (NBs), a vital agricultural environmental indicator, are employed for nutrient management in agricultural areas, using data surveyed by administrative agencies. However, the spatial extent of nutrient data for nutrient budgeting is limited by administrative boundaries according to the surveying organization, posing challenges in interpreting spatial patterns at the watershed level. In this study, a novel approach was developed to identify priority nutrient management areas by applying hot spot spatial analysis to watershed-level NBs, considering hydrological characteristics. This method was applied to approximately 850 subwatersheds across the Republic of Korea, where land cover characteristics are complex. Reassessing nutrient budgets at the watershed scale, accounting for overlapping administrative boundary areas and crop cultivation ratios, indicated similar levels between the two methods. Hot spot analysis revealed that watersheds with elevated NBs mirrored the spatial patterns of livestock excreta and cropland. The spatial distribution characteristics of watersheds with high nutrient levels in rivers corresponded with the concentration characteristics of industrial and commercial areas. Therefore, applying watershed-level NBs based on land cover ratios that consider nutrient input characteristics in agricultural regions is deemed appropriate for selecting priority nutrient management areas. Collectively, this study presents a method for selecting nutrient management priority areas by simultaneously considering the spatial characteristics of various environmental factors, such as land cover, livestock excreta, river water quality, and land area-based watershed-specific NBs. The proposed approach, considering mixed land cover characteristics, is anticipated to be valuable for selecting priority management areas in watersheds with diverse pollution sources. Future research is needed to explore nutrient budgets within watersheds, the influence of land use on pollution sources, and their correlation with water quality.

VGG19 demonstrates the highest accuracy rate in a nine-class wound classification task among various deep learning networks: a pilot study.

BACKGROUND: Current literature suggests relatively low accuracy of multi-class wound classification tasks using deep learning networks. Solutions are needed to address the increasing diagnostic burden of wounds on wound care professionals and to aid non-wound care professionals in wound management. OBJECTIVE: To develop a reliable, accurate 9-class classification system to aid wound care professionals and perhaps eventually, patients and non-wound care professionals, in managing wounds. METHODS: A total of 8173 training data images and 904 test data images were classified into 9 categories: operation wound, laceration, abrasion, skin defect, infected wound, necrosis, diabetic foot ulcer, chronic ulcer, and wound dehiscence. Six deep learning networks, based on VGG16, VGG19, EfficientNet-B0, EfficientNet-B5, RepVGG-A0, and RepVGG-B0, were established, trained, and tested on the same images. For each network the accuracy rate, defined as the sum of true positive and true negative values divided by the total number, was analyzed. RESULTS: The overall accuracy varied from 74.0% to 82.4%. Of all the networks, VGG19 achieved the highest accuracy, at 82.4%. This result is comparable to those reported in previous studies. CONCLUSION: These findings indicate the potential for VGG19 to be the basis for a more comprehensive and detailed AI-based wound diagnostic system. Eventually, such systems also may aid patients and non-wound care professionals in diagnosing and treating wounds.

Measurement of the thickness and refractive index of a thin film by analyzing reflected interference fringes.

We propose a novel, to the best of our knowledge, method to estimate the thickness and refractive index of a thin film by analyzing the reflectance as a function of the incidence angle. In most cases, interference fringes cannot be obtained from a film within a practical angular range unless it is much thicker than the wavelength. This problem was solved by adopting a high-index material as the medium of incidence, in which case several cycles of interference fringes were observed within a small range of incidence angles near the critical angle, allowing a fringe analysis. Consequently, the thicknesses, as well as the refractive indices of dielectric thin films, could be estimated. Our proposed method gave uncertainties of 20 nm and 0.0004 for the thickness and refractive index measurements, respectively.

Conscious Sedation Methods for Blepharoplasty in Day Surgery.

Midazolam and fentanyl, in combination, are the most commonly used medications for conscious sedation in day aesthetic surgeries. Dexmedetomidine is popularly used in the sedation protocol of our hospital due to its reduced respiratory depression. However, its sedation benefits in facial aesthetic surgeries, like blepharoplasty, have not been well-evaluated. We retrospectively compared individuals sedated with midazolam and fentanyl bolus injection (N = 137) and those sedated with dexmedetomidine infusion (N = 113) to determine which is more suitable for blepharoplasty with a mid-cheek lift. The total amount of local anesthetic (p < 0.001), postoperative pain (p = 0.004), ketoprofen administration (p = 0.028), and the number of hypoxia episodes (p < 0.001) and intraoperative hypertension (p = 0.003) were significantly lower in the dexmedetomidine group. Hypoxia severity (p < 0.001) and minor hematoma formation (p = 0.007) were also significantly lower in the dexmedetomidine group. Sedation with dexmedetomidine infusion is associated with less hematoma formation than sedation with midazolam and fentanyl bolus pattern due to hemodynamic stability and analgesic effects. Dexmedetomidine infusion may be a good alternate sedative for lower blepharoplasty.

Lymphatic complex transfer as combined lymph vessel and node transfer for advanced stage upper extremity lymphedema.

OBJECTIVE: Lymphedema, especially in the advanced stage, is a growing challenge in extremity reconstruction, with few applicable surgical methods. Despite its importance, no consensus has been reached regarding a single surgical method yet. Herein, the authors introduce a novel concept of lymphatic reconstruction yielding promising results. METHODS: We included 37 patients with advanced-stage upper extremity lymphedema who underwent lymphatic complex transfers, consisting of both lymph vessel and node transfers, from 2015 to 2020. We compared the preoperative and postoperative (last visit) mean circumferences and volume ratios between the affected and unaffected limbs. Changes in the Lymphedema Life Impact Scale scores and complications were also investigated. RESULTS: The circumference ratio (affected to unaffected limbs) improved at all measuring points (P < .05), while the volume ratio showed a decrease from 1.54 to 1.39 (P < .001). The mean Lymphedema Life Impact Scale decreased from 48.1 ± 15.2 to 33.4 ± 13.8 (P < .05). No donor site morbidities, including iatrogenic lymphedema or any other major complications, were observed. CONCLUSIONS: A new technique for lymphatic reconstruction, lymphatic complex transfer, may be useful in cases of advanced stage lymphedema because of its effectiveness and the low possibility of donor site lymphedema.

Comparing Complications of Biologic and Synthetic Mesh in Breast Reconstruction: A Systematic Review and Network Meta-Analysis.

Background In breast reconstruction, synthetic meshes are frequently used to replace acellular dermal matrix (ADM), since ADM is expensive and often leads to complications. However, there is limited evidence that compares the types of substitutes. This study aimed to compare complications between materials via a network meta-analysis. Methods We systematically reviewed studies reporting any type of complication from 2010 to 2021. The primary outcomes were the proportion of infection, seroma, major complications, or contracture. We classified the intervention into four categories: ADM, absorbable mesh, nonabsorbable mesh, and nothing used. We then performed a network meta-analysis between these categories and estimated the odds ratio with random-effect models. Results Of 603 searched studies through the PubMed, MEDLINE, and Embase databases, following their review by two independent reviewers, 61 studies were included for full-text reading, of which 17 studies were finally included. There was a low risk of bias in the included studies, but only an indirect comparison between absorbable and non-absorbable mesh was possible. Infection was more frequent in ADM but not in the two synthetic mesh groups, namely the absorbable or nonabsorbable types, compared with the nonmesh group. The proportion of seroma in the synthetic mesh group was lower (odds ratio was 0.2 for the absorbable and 0.1 for the nonabsorbable mesh group) than in the ADM group. Proportions of major complications and contractures did not significantly differ between groups. Conclusion Compared with ADM, synthetic meshes have low infection and seroma rates. However, more studies concerning aesthetic outcomes and direct comparisons are needed.

Skin hydration level cutoff value to predict wound healing potential in diabetic foot ulcers.

AIMS: Transcutaneous oxygen pressure (TcPO2) is a reliable predictor of wound healing in diabetes patients; however, measurements are cumbersome. Previously, we demonstrated that skin hydration in the feet of patients with diabetic foot ulcers (DFU) is influenced by microcirculation rather than peripheral nerve function. Furthermore, skin hydration level before recanalization can predict wound healing better than TcPO2. This study investigated the skin hydration level cutoff value to predict DFU healing. METHODS: We retrospectively enrolled 834 patients with DFU. Wound healing outcomes were graded as healed without amputation or with minor/major amputation. Receiver operating characteristic analysis was used to evaluate the ability of skin hydration to predict wound healing outcomes and determine the optimal cutoff value for subsequent analyses. RESULTS: Average skin hydration values in the healed without and with amputation groups were 25.0 ± 7.4 arbitrary units (a.u.) and 17.5 ± 5.7 a.u., respectively (P < 0.001). The healing rate without amputation increased with skin hydration. A skin hydration value ≥ 21 a.u. significantly lowered the incidence of amputation. The cutoff value was 21 a.u. [(Youden's index, sensitivity, specificity, P-value) = (1.6, 92, 69.6, P < 0.001)]. CONCLUSIONS: A minimal skin hydration value of 21 a.u. is required for diabetic wound healing.

Impact assessment of on-site swine wastewater treatment facilities on spatiotemporal variations of nitrogen loading in an intensive livestock farming watershed.

Excess nitrogen (N) resulting from human activity causes environmental issues, including eutrophication in agricultural watersheds with intensive livestock farming. Among the N sources in Korea, on-site swine wastewater treatment facilities (OSWTFs) tend to be densely distributed in watersheds with intensive livestock farming. Therefore, it is critical to sustainably manage livestock excreta. This study used the Soil and Water Assessment Tool (SWAT) to investigate the effects of various pollution sources, including OSWTFs, on N loads in rivers in the Cheongmi watershed, which is an intensive livestock farming and agricultural area in Korea. The simulated hydrological and water quality outputs were calibrated and validated for 2012-2019 using Sequential Uncertainty Fitting ver. 2 in the SWAT-Calibration and Uncertainty Program. The hydrological simulations agreed with the observations, with a correlation coefficient (R2) of ≥ 0.8 and Nash-Sutcliffe coefficient of 0.67-0.86. The simulated total N (TN) was also strongly correlated with the observed monthly average loading (R2, 0.36-0.73) and annual average concentration (R2 ≥ 0.5), demonstrating the reliability of the model constructed herein. A simulation of management scenarios indicates that, if the permissible N concentration in effluent from OSWTFs was reduced to 60 mg N/L, the TN concentrations in rivers would decrease by up to 50%. The findings of this study indicate that more stringent effluent water quality standards are required for OSWTFs to protect water quality and aquatic ecosystems in intensive swine farming watersheds.

Long-Term Resorption Rate of Autogenous Onlay Graft in East Asian Rhinoplasty: A Retrospective Study.

BACKGROUND: Autologous material remains the preferred graft material for use in rhinoplasty. However, resorption rates of autografts remain controversial. In addition, long-term follow-up studies on autografts are rare. Thus, the objective of the present study was to access long-term resorption rates of various autologous grafts on the upper nasal third. METHODS: Medical records of patients who had undergone septorhinoplasty with dorsal augmentation using autologous tissues between 2009 and 2018 were retrospectively reviewed. Autogenous grafts applied on the nasal dorsum were categorized into three groups: rolled superficial mastoid fascia, diced cartilage wrapped with superficial mastoid fascia, and rolled sacral dermis. Preoperative and postoperative photographs were used to evaluate resorption rates and projection. RESULTS: The rolled sacral dermis group showed a steep increase in postoperative projection but a sharp decrease in long-term follow-up projection compared to the other two groups. Among these three groups, there were statistically significant trend differences in rhinion (p < 0.001) and ½ nasion-rhinion point (p < 0.001), but not in nasion. Of these three groups, the rolled sacral dermis group showed the most projection, followed by the diced cartilage wrapped with superficial mastoid fascia group. The resorption rate was the highest in the rolled superficial mastoid fascia group (p < 0.001). Regarding resorption rates in the other two groups, the rolled sacral dermis group had a higher rate than the diced cartilage wrapped with superficial mastoid fascia group. CONCLUSIONS: At least 50 percent of resorption was observed in almost all groups in the long term. The choice of graft material and proper decision-making could determine success or failure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Establishment and characterization of two human cutaneous angiosarcoma cell lines, KU-CAS3 and KU-CAS5.

BACKGROUND: Cutaneous angiosarcoma (CAS) is a rare but fatal cancer. Established CAS cell lines are necessary for the investigation of their properties and treatment options. METHODS: Two cell lines, KU-CAS3 and KU-CAS5, were established from human angiosarcoma specimens obtained from the scalp. Flow cytometric assay, tube formation assay, low-density lipoprotein (LDL) uptake assay, immunofluorescence analysis, real-time PCR, tumorigenesis assay, and STR analysis were conducted. RESULTS: The cells showed endothelial cell properties, based on the cobblestone appearance upon reaching confluence, CD31 positivity, tube-formation activity, active uptake of acetylated LDL, and vWF expression. The two cell lines expressed relatively high levels of adrenergic ß2 receptor, and the VEGF1 and VEGF2 receptors. In the in vivo study, the growing neoplasms, confirmed as CAS, were identified as subcutaneous dark papules. KU-CAS cell lines were considered authentic based on STR profiling. CONCLUSIONS: KU-CAS3 and KU-CAS5 are the first human CAS cell lines having tumorigenic potential in vivo.

Chemical Sterilization of Lipoplasty Cannula and Nontuberculous Mycobacteria Disinfection: An Experimental Study.

BACKGROUND: Nontuberculous mycobacteria are commonly found pathogens; however, skin and soft tissue infections due to nontuberculous mycobacteria are often associated with surgical procedures, particularly after lipoplasty. Although nontuberculous mycobacteria are resistant to some chemical disinfectants, glutaraldehyde, peracetic acid, povidone iodine, alcohol, and chlorine are still used for the sterilization of medical instruments. This study investigated the efficacy of various disinfectants in a fatty environment with adipose and a bloody environment without adipose. In addition, this study was also used to identify the most effective disinfectant against nontuberculous mycobacteria. METHODS: Three nontuberculous mycobacteria (Mycobacterium avium, M. abscessus, and M. fortuitum), pathogens frequently found in skin and soft tissue infections, were used. Seven chemical disinfectants were tested in both fatty and bloody environments. The disinfectants used were considered to have a sterilization effect when the log10 reduction factor exceeded 5. RESULTS: Most disinfectants had some sterilizing effects against nontuberculous mycobacteria; however, glutaraldehyde was the most effective against all 3. Chlorhexidine and povidone iodine also displayed sterilizing effects. Of the disinfectants tested, only alkyldiaminoethylglycine hydrochloride showed a diminished effect with statistical significance, specifically against M. fortuitum in a fatty environment, whereas it had effective results in a bloody environment. CONCLUSIONS: Glutaraldehyde showed the greatest sterilizing effect on nontuberculous mycobacteria with a log10 reduction factor >5 in both fatty and bloody environments. However, some chemical disinfectants did not show sufficient sterilizing effects in a fatty environment and, therefore, should be used with caution for the sterilization of nontuberculous mycobacteria. LEVEL OF EVIDENCE: Level II.

Vascularized lymph node transfer for surgical treatments of upper versus lower extremity lymphedema.

OBJECTIVE: The purpose of this study was to compare clinical outcomes after vascularized lymph node transfer (VLNT) for the treatment of lymphedema performed on the upper and lower extremities. METHODS: Between April 2015 and January 2020, 71 patients with advanced-stage lymphedema, categorized as International Society of Lymphology late stage 2 or 3, who underwent VLNT in upper and lower extremities were included in this study. Thirty-seven and 34 patients underwent VLNT in upper and lower extremities, respectively. The circumference of the affected and unaffected extremities was measured at baseline, follow-up visits, and at the last visit. The circumference was measured in six places on the extremities, and the circumference and volume percent differences between the affected and unaffected extremities were calculated. First, we compared preoperative and postoperative extremity circumferences in the overall, upper, and lower extremity groups. Second, we compared circumference and volume percent differences between the affected and unaffected extremities calculated at the last visit to identify the degree of improvement by VLNT in the upper and lower extremity groups. RESULTS: The results of the comparative analysis between the preoperative and postoperative extremity circumferences showed that all postoperative extremity circumferences measured at the last visit were decreased compared with the preoperative values in the overall, upper, and lower extremity groups. In the upper extremity group, the circumference percent difference measured at the elbow was 23.1% before surgery and decreased to 13.4% at the last visit (P < .001). In the lower extremity group, the circumference percent difference measured at the knee was 24.4% before surgery and decreased to 17.4% at the last visit (P = .003). In the results of comparative analysis between the upper and lower extremity groups, there was a statistically significant difference in the postoperative circumference percent differences at the elbow/knee calculated at the last visit (P = .048). Similarly, there were statistically significant differences in circumference percent differences in two of six measurement sites at the last visit between the upper and lower extremity groups. However, there was no statistically significant difference in the volume percent difference calculated at the last visit between the upper and lower extremity groups. CONCLUSIONS: These results demonstrate that VLNT may be effective in treating patients with advanced-stage lymphedema. However, patients with upper extremity lymphedema demonstrate superior outcomes compared with those with lower extremity lymphedema.

Concentrations and Risk Assessments of Antibiotics in an Urban-Rural Complex Watershed with Intensive Livestock Farming.

Antibiotics used for the treatment of humans and livestock are released into the environment, whereby they pose a grave threat to biota (including humans) as they can cause the emergence of various strains of resistant bacteria. An improved understanding of antibiotics in the environment is thus vital for appropriate management and mitigation. Herein, surface water and groundwater samples containing antibiotics were analyzed in an urban-rural complex watershed (Cheongmi Stream) comprising intensive livestock farms by collecting samples across different time points and locations. The spatiotemporal trends of the residual antibiotics were analyzed, and ecological and antibiotic resistance-based risk assessments were performed considering their concentrations. The results showed that the concentrations and detection frequencies of the residual antibiotics in the surface water were affected by various factors such as agricultural activities and point sources, and were higher than those found in groundwater; however, frequent detection of antibiotics in groundwater showed that residual antibiotics were influenced by factors such as usage pattern and sewage runoff. Furthermore, few antibiotics posed ecological risks. The risk assessment methods adopted in this study can be applied elsewhere, and the results can be considered in the environmental management of residual antibiotics in the Cheongmi Stream watershed.

Strong links between load and manure and a comprehensive risk assessment of veterinary antibiotics with low KOW in intensive livestock farming watersheds.

Various veterinary antibiotics (VAs) are used in large quantities as an essential component for intensive livestock farming, and can flow into the environment from various pollution sources. In this study, VAs in surface water and groundwater in the Gwangcheon stream watershed, an intensive livestock farming area in Korea, were analyzed using ultra-high-performance liquid chromatograph-quadrupole orbitrap high-resolution mass spectrometer with online solid phase extraction. Although the selected VAs are relatively mobile and have low KOW values it is significant to assess their fates and ecological risks in the environment. The concentration of VAs in the surface water was higher than that in groundwater by approximately 23-fold, indicating that the former were directly introduced from pollution sources such as livestock manure. An analysis of the correlation between livestock manure production and the residuals of VAs in the stream showed a high linearity (R2 > 0.70), confirming that livestock excreta significantly contributed to the VAs in the watershed. A combined evaluation of environmental behaviors and ecological risks of VAs was performed for the first time using persistence, bioaccumulation potential, and toxicity properties and risk quotient values of VAs. Trimethoprim showed persistence and a potential impact on the ecosystem. The cumulative risk quotient values at one sampling point exceeded 1 indicating that several VAs can cumulatively cause local risk. The risk assessment method considering pollution sources, different locations, and correlation analysis applied in this study will be useful in evaluating the impacts of trace pollutants in watersheds.

Identifying nitrogen sources in intensive livestock farming watershed with swine excreta treatment facility using dual ammonium (δ15NNH4) and nitrate (δ15NNO3) nitrogen isotope ratios axes.

We proposed a novel approach based on dual ammonium and nitrate nitrogen isotope ratios (δ15NNH4 and δ15NNO3, respectively) axes to identify nitrogen sources in intensive livestock farming watersheds, especially those with swine excreta treatment facilities. The δ15NNH4 and δ15NNO3 values in water samples were measured monthly in 2016-2017. Soil and mineral fertilizers, sewage, sewage effluent, manure, and swine effluents were the five sources considered to identify nitrogen sources. The results showed that nitrogen pollution from agricultural activities was well reflected by the seasonal δ15NNH4 and δ15NNO3 patterns in the river, and microbial nitrification was suggested as the dominant nitrogen transformation process in the river. This study revealed that δ15NNH4 and δ15NNO3 axes provided better results than the traditionally used nitrate oxygen (δ18ONO3) and δ15NNO3 axes for identifying nitrogen sources in agricultural watersheds with swine excreta treatment facilities. The mixing model results showed that stream water was severely contaminated with swine effluents (e.g., a mean minimum contribution of 31%), thus affecting the quality of the mainstream (p = 0.068 < 0.10). This study was the first successful application of dual δ15NNH4 and δ15NNO3 axes to better understand nitrogen sources in intensive livestock farming watersheds with swine excreta treatment facilities.

Late-Onset Inflammation in Asian Rhinoplasty Using Alloplastic Implants.

BACKGROUND: Late-onset inflammation is a rare complication that may occur several months to years after undergoing an uneventful rhinoplasty using alloplastic implants and an uneventful postoperative course. Studies to determine the pathophysiological mechanisms of late-onset inflammation related to implants used in rhinoplasty are limited. The purpose of the study was to analyze differences between non-healthy capsules (NHC) with late-onset inflammation and healthy capsules (HC) without inflammation as controls to determine the possible cause of the inflammation. METHODS: Between April 2009 and May 2018, 39 patients who underwent rhinoplasty with alloplastic implants underwent histological studies. Twenty-one patients in the NHC group showed late-onset inflammation, while 18 patients in the HC group did not display late-onset inflammation. Capsules around the alloplastic implants were harvested, and histological studies using hematoxylin and eosin, Masson's trichrome, colloidal iron, and CD31 staining were performed and compared between the NHC and HC groups. RESULTS: In hematoxylin and eosin and Masson's trichrome staining, edematous granulation tissues, inflammatory cellular contents, and a disorganized collagen layer were increased in the NHC group compared to the HC group. The colloidal iron staining revealed mucin deposition in the NHC group. CD31-positive cells were observed lining the capsule in both groups; however, the lining cells were damaged in the NHC group. CONCLUSION: Granulation tissues, inflammatory reaction, collagen degeneration, mucin deposition, and endothelial lining cell damage were greater in the NHC group compared to the HC group. Damaged capsules may play a crucial role in late-onset inflammation. LEVEL OF EVIDENCE IV: 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 .

Aesthetic Comparison of Abdominal Donor Site Scar Between Absorbable Dermal Staple and Subcutaneous Suture after Autologous Breast Reconstruction: A Prospective Randomized Controlled, Double-Blinded Study.

BACKGROUND: Abdominal tissue transfer has become the most commonly used tool for breast reconstruction. However, a secondary operator is often responsible for donor closure, which leaves dissatisfaction to patients due to inconsistent donor scars. Now, an absorbable dermal stapler is popularized worldwide and currently used for wound closure in many surgical fields. In this study, we aim to evaluate the abdominal donor site scar in using an absorbable dermal staple compared to a conventional suture. METHODS: This is a prospective, randomized controlled and double-blinded study. Between January 2018 and April 2019, a total of 30 patients who underwent breast reconstruction using abdominal flap were included. Donor sites were divided into equal halves, and the each dermal layer was sutured with either dermal staples or traditional suturing, respectively. At 1, 3 and 6 months after operation, the scar was evaluated by two blinded plastic surgeons by using the modified Manchester scar scale (MSS). RESULTS: An averaged sum of modified MSS was lower for the side sutured with a dermal stapler at the first month (11.76 ± 2.12 vs. 12.28 ± 2.03, p = 0.097), third month (12.17 ± 1.86 vs. 12.62 ± 2.31, p = 0.301) and sixth month (11.28 ± 2.63 vs. 12.14 ± 2.76, p = 0.051). Also, the dermal stapler side scored significantly higher for patient satisfaction than did the suture side (4.03 ± 0.98 vs 3.66 ± 0.97, p < 0.05). CONCLUSION: The objective outcome of the scar closed by an absorbable dermal stapler was not statistically superior to conventional suturing. (p > 0.05) In the subjective outcome, however, it showed a significantly higher patients' satisfaction (p < 0.05). 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 .