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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(10): 1323-1327, 2021 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-34651488

RESUMO

Objective: To summarize the difficulties and key points of free deep inferior epigastric artery perforator flap (DIEP) transplantation in breast shaping of two-staged breast reconstruction with vertical scar. Methods: The clinical data of 32 postoperative breast cancer patients after mastectomy who underwent free DIEP transplantation for breast reconstruction between October 2015 and October 2019, whose original surgical incisions were all vertical and longitudinal, were retrospectively analysed. All the patients were female, aged from 31 to 42 years, with an average of 34.6 years. The disease duration of breast cancer ranged from 9 to 48 months (mean, 22.8 months). Free DIEP pedicled with contralateral vessels were used in all cases, and the recipient vessels were intrathoracic vessels. Among them, 17 flaps were placed longitudinally, 15 flaps were placed obliquely; Z-shaped flaps were used in 18 cases to adjust the chest wall skin contracture, and contralateral breast reduction and mastopexy were accomplished at the same time in 23 cases. Results: All DIEP survived completely, and all donor and recipient sites healed by first intention. Internal thoracic lymph node metastasis was found in 1 case and treated with radiotherapy. All 32 cases were followed up 9-48 months, with an average of 19.4 months. The appearance and texture of all flaps were satisfactory, and only linear scar was left in donor site. Eleven patients underwent further autologous fat transplantation and nipple reconstruction. All patients had no effect on abdominal wall activity, and no local recurrence and metastasis was found. Conclusion: It is difficult to use free DIEP for two-staged breast reconstruction in patients received mastectomy with vertical longitudinal scar left. Combined with different breast shaping techniques, the outcomes can significantly improve.


Assuntos
Neoplasias da Mama , Mamoplastia , Retalho Perfurante , Neoplasias da Mama/cirurgia , Cicatriz/cirurgia , Artérias Epigástricas/cirurgia , Feminino , Humanos , Mastectomia , Recidiva Local de Neoplasia , Estudos Retrospectivos
2.
J Med Case Rep ; 15(1): 506, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34625100

RESUMO

BACKGROUND: Cesarean scar pregnancy is a complicated and potentially life-threatening type of ectopic pregnancy. This study reports two women with cesarean scar pregnancy who were successfully treated with systemic methotrexate administration, and two other women who needed local re-administration of methotrexate after systemic injection. CASE PRESENTATION: Four Iranian pregnant women aged 29-34 years who were between 5  to 7 gestational weeks with cesarean scar pregnancy diagnosis are described. After a single dose of systemic methotrexate injection, the level of serum beta-human chorionic gonadotropin decreased in two of the women, while fetal activity was observed in the other two women. In the latter patients, methotrexate was injected under transvaginal ultrasound guidance into the gestational sac. As a result, the serum beta-human chorionic gonadotropin level first increased and then decreased in these patients. During the follow-up period, all the patients were stable and no complications were observed. Serum beta-human chorionic gonadotropin levels reached the non-pregnancy range from 4 to 9 weeks after treatment. CONCLUSION: When diagnosed at early gestation, cesarean scar pregnancy can be treated successfully with methotrexate administration alone. The clinicians should be aware that the beta-human chorionic gonadotropin level may initially increase after methotrexate injection in some patients. However, the final outcome will be promising if the patients remain stable.


Assuntos
Abortivos não Esteroides , Gravidez Ectópica , Cesárea/efeitos adversos , Cicatriz/tratamento farmacológico , Cicatriz/patologia , Feminino , Humanos , Irã (Geográfico) , Gravidez , Gravidez Ectópica/diagnóstico por imagem , Gravidez Ectópica/tratamento farmacológico , Gravidez Ectópica/etiologia
3.
J Wound Care ; 30(Sup9a): Vi-Vx, 2021 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-34597168

RESUMO

AIMS: Tamanu is a plant oil derived from the fruit and seeds of the Calophyllum inophyllum tree. Although scientific data on tamanu oil are limited, it is recommended worldwide for the treatment of abrasions, burns, diabetic wounds and scars. This study aimed to compare the wound healing efficacy of the topical use of tamanu oil with a reference drug in rats. METHODS: Uniform wounds were induced on the dorsum of 21 rats, randomly divided into three groups. The control group received normal saline; the tamanu group received tamanu oil; and the centella group was treated with Centella asiatica. Wound healing was clinically evaluated using wound healing scoring and wound contraction. A biopsy was taken from the wound sites of each rat on days 7, 14 and 21 for histopathological evaluation. RESULTS: Wound contraction was significantly lower in the tamanu group compared with the other groups. On day 7, the intensity of macrophage infiltration and mature granulation tissues were significantly higher in the centella and tamanu groups than in the control group. Fibrosis and collagen density were higher in the tamanu group than the other groups on day 7. CONCLUSION: In wound healing in rats, tamanu oil accelerated the formation of macrophage-granulation tissues-fibrosis and resulted in less wound contraction.


Assuntos
Tecido de Granulação , Cicatrização , Animais , Biópsia , Cicatriz , Macrófagos , Ratos
4.
Shanghai Kou Qiang Yi Xue ; 30(3): 332-336, 2021 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-34476456

RESUMO

PURPOSE: To explore the feasibility of applying bilateral free expanded scapular flaps to treat extensive cervicomandibular scar in children and adolescents. METHODS: This study reviewed 7 children and adolescent patients who received bilateral expanded scapular flaps to treat extensive cervicomandibular scars in the Pediatric Plastic Surgery Ward from August 2018 to December 2020. The scars in all patients involved neck, mandible, and anterior chest. The cervical scars involved the anterior neck and one or both sides of the lateral neck, and there were varying degrees of cervical dysfunction and mandibular dysplasia. The operation was completed into two stages. In the first stage, the expanded circumflex scapular artery perforator flaps were designed on both sides of the back and soft tissue expanders were implanted. The expansion process lasted for 6-14 months. In the second stage, the scar tissue was removed and contracture was released, and the expanded flaps were harvested. The cervical wound was repaired with free flap transplantation by anastomosing the facial artery and vein with the circumflex scapular artery and vein. The donor sites were closed directly. RESULTS: In this series of 7 patients, one patient had poorly healed incision after the expander was implanted. One expanded flap ruptured before the second-stage surgery, which was successfully treated by secondary surgery. One patient had expansion problem due to the blockage of the internally placed injection bottle, which was treated by placing the injection bottle externally. One patient developed a small area of ischemic necrosis at the distal end of the flap after transplantation, which was treated conservatively with dressing change. The postoperative follow-up was 6 months to 2 years. The cervico-mandibular angle restored to normal range, the cervical extension, flexion, and rotation were significantly improved. Two patients underwent flap thinning and scar releasing. CONCLUSIONS: The route of the circumflex scapular artery is constant. Bilateral expanded scapular flap transplantation can be used to repair extensive cervicomandibular scar in children and adolescent patients. The flap donor site is concealed and secondary damage is minimal.


Assuntos
Contratura , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Adolescente , Criança , Cicatriz/cirurgia , Contratura/cirurgia , Humanos , Transplante de Pele , Resultado do Tratamento
5.
Nat Commun ; 12(1): 5501, 2021 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-34535655

RESUMO

Fibrotic scar tissue limits central nervous system regeneration in adult mammals. The extent of fibrotic tissue generation and distribution of stromal cells across different lesions in the brain and spinal cord has not been systematically investigated in mice and humans. Furthermore, it is unknown whether scar-forming stromal cells have the same origin throughout the central nervous system and in different types of lesions. In the current study, we compared fibrotic scarring in human pathological tissue and corresponding mouse models of penetrating and non-penetrating spinal cord injury, traumatic brain injury, ischemic stroke, multiple sclerosis and glioblastoma. We show that the extent and distribution of stromal cells are specific to the type of lesion and, in most cases, similar between mice and humans. Employing in vivo lineage tracing, we report that in all mouse models that develop fibrotic tissue, the primary source of scar-forming fibroblasts is a discrete subset of perivascular cells, termed type A pericytes. Perivascular cells with a type A pericyte marker profile also exist in the human brain and spinal cord. We uncover type A pericyte-derived fibrosis as a conserved mechanism that may be explored as a therapeutic target to improve recovery after central nervous system lesions.


Assuntos
Sistema Nervoso Central/patologia , Cicatriz/patologia , Pericitos/patologia , Envelhecimento/fisiologia , Animais , Astrócitos/patologia , Lesões Encefálicas Traumáticas/patologia , Isquemia Encefálica/patologia , Neoplasias Encefálicas/patologia , Córtex Cerebral/patologia , Modelos Animais de Doenças , Encefalomielite Autoimune Experimental/patologia , Matriz Extracelular/metabolismo , Fibroblastos/patologia , Fibrose , Glioblastoma/patologia , Humanos , AVC Isquêmico/patologia , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Glicoproteína Mielina-Oligodendrócito , Fragmentos de Peptídeos , Receptor beta de Fator de Crescimento Derivado de Plaquetas/metabolismo , Medula Espinal/patologia , Medula Espinal/ultraestrutura , Traumatismos da Medula Espinal/patologia , Células Estromais/patologia
6.
West Afr J Med ; 38(8): 785-790, 2021 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-34505184

RESUMO

BACKGROUND AND AIMS: Studies of adult female acne vulgaris are few despite its increasing presentation in dermatology clinics. Adult female acne is classified as either late onset, persistent acne or return acne with a mixed pattern of inflammation in most females. The aim of this study was to document the socio-demographic characteristics (late onset, persistent acne, age, pre-menstrual flare) and clinical profile (severity, pattern, type of lesions, scarring and type of scars) of adult female acne patients. METHODOLOGY: Cross sectional descriptive study of 56 adult female acne patients aged 25 years and above. Patients were clinically examined and severity of acne graded with the Comprehensive Acne Severity Scale. Socio-demographic data and clinical profile was documented using a questionnaire designed for the study. Data analysis was performed using the SPSS version 22. Level of significance of all tests was set at 5%. RESULTS: Age range was 25-67 years with a mean age of 33.4 years. Prevalence of adult female acne was 19.3% amongst female patients seen in the clinic. Acne was persistent in 55.4%, late onset in 44.6%, only inflammatory in 5.4%, only non-inflammatory in 42.9%, and a mixed pattern of inflammation in 51.8%. Location of acne was facial only in 80.4% with extra facial involvement in 19.6%. Acne was severe, moderate and mild in 35.7%, 44.6%, and 19.6% respectively. Acne scar was present in 87.5%, post inflammatory hyperpigmentation in 65.3%. CONCLUSION: Adult female acne is increasing in prevalence. Acne in adult females is mostly persistent in nature with mixed inflammatory pattern. It affects the whole face and it is associated with scarring.


Assuntos
Acne Vulgar , Acne Vulgar/epidemiologia , Adulto , Idoso , Cicatriz/epidemiologia , Cicatriz/etiologia , Cicatriz/patologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Nigéria/epidemiologia , Índice de Gravidade de Doença , Inquéritos e Questionários , Resultado do Tratamento
7.
Ann Surg ; 274(4): 627-636, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34506318

RESUMO

OBJECTIVE: Demonstrate the impact of IL-10 producing T lymphocytes on mediating dermal scarring. SUMMARY BACKGROUND DATA: We demonstrated that CD4+ cells are essential to improving postinjury wound healing and preventing fibrosis. CD4+ subsets secrete differential cytokine and growth factor profiles, though their role in fibrosis is not known. IL-10, a key anti-inflammatory cytokine shown to promote regenerative wound healing, is secreted by some CD4+ subsets. We, therefore, hypothesize that IL-10 producing CD4+ T lymphocyte subsets selectively attenuate dermal wound fibrosis. METHODS: IL-10-/- and wild-type murine splenocytes were enriched for CD4+ lymphocytes and adoptively transferred into severe combined immunodeficient (SCID) mice that received full-thickness wounds which were analyzed at days 7 and 28 for inflammation and collagen content. We then sorted CD4+CD44int/lowFoxP3-CD62L+ T cells (Tnaive) or CD4+CD44HiFoxP3- type 1 regulatory (Tr1) T cell subsets from 10BiT murine splenocytes, activated them, and transferred them into wounds. In vitro, dermal fibroblasts were cocultured with Tnaive or Tr1 and the effect on extracellular matrix (ECM) regulation was analyzed. RESULTS: The anti-inflammatory and antifibrotic effects of CD4+ cells on SCID wounds were lost with cells from IL-10-/- mice. Adoptive transfer of Tr1 into SCID mice resulted in accelerated wound closure at d7 with reduced fibrosis at d28, with Tr1 favoring hyaluronan production by fibroblasts, an ECM molecule implicated in IL-10-induced regenerative healing. CONCLUSIONS: IL-10 producing T-lymphocytes, specifically Tr1, regulate inflammatory cell cytokine expression to promote HA-rich ECM deposition and attenuate fibrosis. Promoting IL-10 producing lymphocytes in wounds may be a therapeutic target to promote regenerative wound healing.


Assuntos
Linfócitos T CD4-Positivos/fisiologia , Cicatriz/patologia , Cicatriz/prevenção & controle , Derme/lesões , Interleucina-10/fisiologia , Cicatrização/fisiologia , Transferência Adotiva , Animais , Cicatriz/etiologia , Derme/patologia , Modelos Animais de Doenças , Camundongos , Camundongos SCID
8.
Am J Case Rep ; 22: e932493, 2021 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-34547012

RESUMO

BACKGROUND Endometriosis is a unique entity described in ample literature as the decidualization of endometrial tissues under the influence of gynecological hormones outside the uterine cavity. The post-surgical presence of ectopic endometrial tissue on the skin is known as abdominal wall endometriosis, cutaneous endometriosis, or scar endometriosis. Iatrogenic implantation of detached endometrial tissues at the incision site is the most widely accepted theory for this rare monad. The unspecific scar endometriosis presentation makes it challenging to diagnose. Moreover, it can easily be confused with hematoma, hernia, lipoma, abscess, scar granuloma, and tumor. Here, we report and discuss a rare case of scar endometriosis with various available treatment modalities. CASE REPORT We delineate a case of a 39-year-old woman with abdominal wall cutaneous endometriosis. An "inverted T" incision opened the abdominal and uterine cavity as it was a problematic preterm breech in labor. After an uneventful postoperative and postpartum period, she presented with a painful, discolored nodular mass of approximately 3 cm in diameter at the left border of the cesarian scar, developed over 1.5 years, often accompanied by drainage of brownish discharge. Ultrasonography with color Doppler showed a hypoechoic lesion with internal vascularity, corroborated our preliminary diagnosis of scar endometriosis, which was further confirmed by surgical excision and histopathology. CONCLUSIONS A proper surgical resection is the standard treatment line for scar endometriosis. However, patients need regular follow-up to look for recurrences, even after treatment. Further studies are recommended to establish factors associated with cutaneous endometriosis recurrence.


Assuntos
Parede Abdominal , Endometriose , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Adulto , Cesárea , Cicatriz , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Humanos , Recém-Nascido , Recidiva Local de Neoplasia/patologia , Gravidez
9.
JNMA J Nepal Med Assoc ; 59(235): 288-291, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-34506448

RESUMO

Cesarean scar pregnancy is a rare form of ectopic pregnancy which may lead to uterine rupture and catastrophic hemorrhage. We report a case of cesarean scar pregnancy in a 35-year-old female with the past history of cesarean section presented with complaints of amenorrhoea for 6 weeks and non-specific  pain. Two Transvaginal sonography was done 48 hours apart which suggested a cesarean scar pregnancy in one and cervical pregnancy on the other. Magnetic Resonace Imaging showed a well-defined cystic lesion of (21x19)mm2 embedded within the previous cesarean scar which confirmed the diagnosis of cesarean scar pregnancy. Laparotomy unveiled uterus around 6 weeks size and a (3x3)cm2 bulge was noted at the site of previous scar in lower uterine segment, where a small incision was given and the gestational sac was removed following which the uterine incision was closed with 2-0 polyglactin suture. High index of suspicion and prompt diagnosis is ofparamount for reducing morbidity and mortality.


Assuntos
Gravidez Ectópica , Ruptura Uterina , Adulto , Cesárea/efeitos adversos , Cicatriz/diagnóstico , Cicatriz/patologia , Feminino , Humanos , Histerotomia , Gravidez , Gravidez Ectópica/diagnóstico por imagem , Gravidez Ectópica/cirurgia , Ruptura Uterina/diagnóstico , Ruptura Uterina/etiologia , Ruptura Uterina/cirurgia
10.
Int J Mol Sci ; 22(16)2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34445709

RESUMO

Mammals rapidly heal wounds through fibrous connective tissue build up and tissue contraction. Recent findings from mouse attribute wound healing to physical mobilization of a fibroelastic connective tissue layer that resides beneath the skin, termed subcutaneous fascia or superficial fascia, into sites of injury. Fascial mobilization assembles diverse cell types and matrix components needed for rapid wound repair. These observations suggest that the factors directly affecting fascial mobility are responsible for chronic skin wounds and excessive skin scarring. In this review, we discuss the link between the fascia's unique tissue anatomy, composition, biomechanical, and rheologic properties to its ability to mobilize its tissue assemblage. Fascia is thus at the forefront of tissue pathology and a better understanding of how it is mobilized may crystallize our view of wound healing alterations during aging, diabetes, and fibrous disease and create novel therapeutic strategies for wound repair.


Assuntos
Tela Subcutânea/patologia , Tela Subcutânea/fisiologia , Cicatrização/fisiologia , Animais , Cicatriz/patologia , Fáscia/patologia , Humanos , Camundongos , Pele/patologia , Tela Subcutânea/metabolismo
11.
J Cosmet Laser Ther ; 23(1-2): 35-40, 2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-34409915

RESUMO

Despite various modalities used for treating acne scars, no single treatment modality was significantly satisfactory. We compare the efficacies of fractional Erbium: yttrium aluminum garnet (Er:YAG), 2940 nm, laser versus long-pulsed Neodymium: yttrium-aluminum-garnet (Nd:YAG), 1064 nm, laser for the treatment of acne scars. Twenty patients were treated in a randomized split-face manner. They underwent three sessions at a three-week interval. Assessment of the patient was done before each treatment and 3 months after the end of the treatment sessions. The treatment effect was evaluated objectively, according to Sharquie scores for grading scarring acne vulgaris and digital photographic assessment and subjectively, according to the patient's satisfaction. Results According to objective Sharquie scores, there were no significant differences in the response between the two types of laser used. Based on the visual analog score, there was a significantly higher score of improvement for the side irradiated with fractional Er:YAG (2940 nm) laser. Subjectively, the patients were significantly satisfied with the results on the fractional Er: YAG than on the long pulsed Nd:YAG side. Both lasers were effective, However, the improvement in appearance of acne scars was better with fractional Er:YAG laser with fewer side effects with Long Pulsed Nd:YAG laser.


Assuntos
Acne Vulgar , Lasers de Estado Sólido , Terapia com Luz de Baixa Intensidade , Acne Vulgar/complicações , Cicatriz/etiologia , Cicatriz/patologia , Cicatriz/radioterapia , Humanos , Lasers de Estado Sólido/efeitos adversos , Resultado do Tratamento
12.
Lupus Sci Med ; 8(1)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34452954

RESUMO

OBJECTIVE: There is a need to identify concerns unique to patients with cutaneous lupus erythematosus (CLE), which may not be captured by current common-practice dermatological quality-of-life tools. This study formally characterises what bothers patients with CLE about their disease by conducting semistructured, qualitative interviews. METHODS: Sixteen patients with CLE were interviewed about how their cutaneous findings impact their daily life. Each interview was transcribed, coded and categorised for recurrent themes. Current CLE activity and damage were also assessed by the Cutaneous Lupus Activity and Severity Index tool. RESULTS: Responses were categorised into six themes, including Fear of Disease Progression, Unwanted Attention, Self-Consciousness, Physical Signs/Symptoms, Emotional Symptoms and Functional Decline. The most commonly reported themes were Self-Consciousness, mentioned by 13 of 16 (81.3%) patients, Physical Symptoms, mentioned by 12 of 16 (75%), and then Fear of Disease Progression, by 11 of 16 (68.8%). Frequently mentioned physical signs/symptoms included erythema, itch, dyspigmentation, scar and alopecia. The physical signs/symptoms were categorised as activity signs/symptoms, damage signs and other. For activity signs, erythema was mentioned most frequently (5 of 16), then scale (2 of 16). For activity symptoms, itch was mentioned most frequently (6 of 16), then pain (5 of 16). For damage signs, dyspigmentation was mentioned most frequently (4 of 16), followed by scarring (3 of 16). Patients less than 60 years old were more likely to report emotional symptoms than older patients (p<0.05), but there was no significant variation in frequency of reported themes between race, sex or subtype of CLE. CONCLUSIONS: These patient experiences and resultant themes elucidated by this study are worth noting in future standardised estimations of the quality of life of patients with CLE. Additionally, the concerns shown by these interviews are important topics for providers to discuss when evaluating patient disease progression.


Assuntos
Lúpus Eritematoso Cutâneo , Transtornos da Pigmentação , Cicatriz/patologia , Eritema , Humanos , Lúpus Eritematoso Cutâneo/diagnóstico , Pessoa de Meia-Idade , Qualidade de Vida
13.
Eur J Obstet Gynecol Reprod Biol ; 264: 363-367, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34391052

RESUMO

Malignant transformation of abdominal wall endometriosis (AWE) is rare. The clinical characteristics and treatment of malignant transformation of AWE are not well known. Therefore, in this review, we performed a thorough search for malignant transformation of AWE on MEDLINE and Web of Science from their inception to May 2021. In total, the data of 46 patients with malignant transformation of AWE were retrieved, and all the data on these patients were collected. After reviewing and analyzing the clinical parameters, we found that cesarean scar was the most common site of malignant transformation of AWE, and the most common pathological type of malignant transformation of AWE was clear cell cancer, followed by endometrioid adenocarcinoma. The main symptoms of malignant transformation of AWE included an abdominal nodule or mass, and ultrasonography was the first choice for diagnosis. The most widely accepted treatment was surgical resection of local lesions with adjunctive chemotherapy and/or radiotherapy, and the overall survival of patients with malignant transformation of AWE was poor. In conclusion, malignant transformation of AWE is rare, and the prognosis is poor. Thus, improving abdominal surgical technology and avoiding iatrogenic ectopia and implantation of the endometrium are necessary to prevent malignant transformation of AWE.


Assuntos
Parede Abdominal , Carcinoma Endometrioide , Endometriose , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/cirurgia , Carcinoma Endometrioide/patologia , Cesárea/efeitos adversos , Cicatriz/patologia , Endometriose/diagnóstico , Endometriose/epidemiologia , Endometriose/terapia , Feminino , Humanos , Gravidez
15.
BMJ Open ; 11(8): e045770, 2021 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-34462279

RESUMO

INTRODUCTION: Recently, the rate of caesarean sections (CS) worldwide has risen and CS-associated complications such as niche have increased substantially. Until now, evidence-based clinical guidelines for the treatment of niche-related symptoms remain absent. In patients with postmenstrual spotting, it has not been studied if the effect of levonorgestrel 52 mg intrauterine system (LNG-IUS 52 mg) is superior to that of hysteroscopy. This study will answer the question of whether LNG-IUS 52 mg is more effective in improving postmenstrual spotting than hysteroscopic niche resection in women with niche-related spotting at 6 months after randomisation. METHODS AND ANALYSIS: This is a randomised controlled trial. A total of 208 women with postmenstrual spotting related to niche in the caesarean uterine scar of at least 2 mm and residual myometrium of at least 2.2 mm evaluated by MRI will be included. Women desiring to conceive within 1 year, with contraindications for LNG-IUS 52 mg or hysteroscopic surgery will be excluded. After informed consent is obtained, eligible women will be randomly allocated to LNG-IUS 52 mg or hysteroscopic niche resection at 1:1. The primary outcome is the efficacy in reducing postmenstrual spotting at 6 months after randomisation. The secondary outcomes include menstrual pattern, total days of blood loss per month, rate of amenorrhoea, side effects and complications.We will use a Visual Analogue Scale for chronic pelvic pain, urological symptoms and women's satisfaction (five-point Likert scale). ETHICS AND DISSEMINATION: The study was approved by the local medical ethics committee and by the Institutional Review Board of the International Peace Maternity and Child Health Hospital, Shanghai, China (No. GKLW 2019-08). Participants will sign a written informed consent before participation. The results of this study will be submitted to a peer-reviewed journal for publication. TRIAL REGISTRATION NUMBER: ChiCTR1900025677.


Assuntos
Dispositivos Intrauterinos Medicados , Levanogestrel , Cesárea/efeitos adversos , Criança , China , Cicatriz , Feminino , Humanos , Levanogestrel/uso terapêutico , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Útero/diagnóstico por imagem , Útero/cirurgia
16.
Eur J Obstet Gynecol Reprod Biol ; 265: 66-73, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34461384

RESUMO

OBJECTIVE: To compare the effect of a hysteroscopic niche resection with a Levonorgestrel-releasing intrauterine device (LNG-IUD, 52 mg) on postmenstrual spotting duration in patients with a symptomatic niche in the uterine cesarean scar. STUDY DESIGN: This prospective cohort study was conducted at the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, China. Patients with postmenstrual spotting symptomatic niches were allocated to hysteroscopy group or LNG-IUD group based on the shared medical decision-making approach, and were followed up for 1 year after treatment. MAIN OUTCOME MEASURES: The primary outcome was reduced postmenstrual spotting days at 6th month after treatment. Secondary outcomes were effectiveness rate (proportion of patients with spotting days reduced by at least 50% from baseline), menstrual characteristics, menstruation satisfaction, direct medical costs, complications and side effects. RESULTS: 78 out of the 82 eligible patients were included, 36 patients in both group finished 1-year follow-up. Reduced spotting days at the 6th month was 7 days in LNG-IUD group, significantly higher than 5 days in hysteroscopy group, P = 0.004; The effectiveness rate increased over time within 1 year after the insertion of LNG-IUD (63.89%, 83.33%, 88.89%, 88.89%, P for trend = 0.006), while no trend change was observed in hysteroscopy group (71.05%, 71.05%, 66.67%, 61.11%, P for trend = 0.77). The mean direct medical costs were 817[785,856] $ in the hysteroscopy group and 243[239,255] $ in the LNG-IUD group (p<0.001). 2 patients removed IUD and 2 patients reported weight gain of more than 5 kg and breast distended pain in LNG-IUD group; 2 patients got pregnant in hysteroscopy group. No serious complications were observed in both groups. CONCLUSIONS: LNG-IUD is more effective in the treatment of postmenstrual spotting from the 6th month onwards than a hysteroscopic niche resection in patients with a symptomatic niche at lower direct costs.


Assuntos
Dispositivos Intrauterinos Medicados , Dispositivos Intrauterinos , Criança , China , Cicatriz , Feminino , Humanos , Levanogestrel , Gravidez , Estudos Prospectivos
17.
Khirurgiia (Mosk) ; (8): 107-111, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34363452

RESUMO

Periorbital soft tissue reconstruction has always been a difficult problem. There are several techniques for correction of supraorbital defects, most often we are talking about aged patients with sagging skin. Local skin grafting is usually used. However, this approach can result additional scars on the face requiring further multiple corrections. We report a good functional and aesthetic result in a young patient after reconstruction of supraorbital region with a pedicled skin flap from periauricular region under reverse blood flow. This technique can be taken into account for complex small periorbital soft tissue defects up to 5.0 x 5.5 cm. The flap adequately closes the defect and repairs facial contour and symmetry.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Transplante de Pele , Idoso , Cicatriz/cirurgia , Face/cirurgia , Humanos , Retalhos Cirúrgicos
18.
J Wound Care ; 30(8): 626-630, 2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34382853

RESUMO

OBJECTIVE: The type of suture material affects the quality of scars. The aim of this study was to find the superior suture material for reduction mammoplasty between Prolene and Monocryl based on the comparison of scars. METHOD: A prospective observational study was conducted at a university-based hospital in Mashhad, Iran between October 2015 and September 2017. Monocryl and Prolene suture materials, used for closing the outermost layer in mammoplasty, were compared. Patients' incision scars were assessed objectively according to the Patient and Observer Scar Assessment (POSAS) criteria. The relevant CONSORT guideline was used for reporting this study. RESULTS: Seventy-eight women with a mean age of 36.8±9.5 years were entered into the study. The frequency of wound healing in both groups was 97.4% 1 month after surgery and by the third visit, 3 months after surgery, only one patient had a stretched scar. Moreover, wound inflammation in the first two visits was less frequent in the Prolene group that healed completely 3 months after surgery (after excluding the one patient with wide scar inflammation). The frequency of itching of the wound in the Monocryl group was 24.4%, 11.5% and 12.8% in the three follow-up visits, respectively, and the values for the Prolene group were 24.4%, 9.0% and 6.4%, respectively. No significant difference was seen between the two groups in terms of wound healing, inflammation and itching (p>0.05). Overall, 94.8% of patients were satisfied with the surgery. CONCLUSIONS: Our study revealed that there was no significant difference between Monocryl and Prolene. Hence, either of the two suture materials can be used for wound closure in reduction mammoplasty.


Assuntos
Mamoplastia , Ferida Cirúrgica , Adulto , Cicatriz/patologia , Dioxanos , Feminino , Humanos , Mamoplastia/efeitos adversos , Pessoa de Meia-Idade , Poliésteres , Polipropilenos , Técnicas de Sutura , Suturas
20.
Zhonghua Shao Shang Za Zhi ; 37(8): 711-717, 2021 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-34404161

RESUMO

Objective: To explore the clinical effect of the fractional carbon dioxide laser in the treatment of contracture scars. Methods: A retrospective before-after self-control study was conducted. From December 2016 to April 2021, 16 patients (7 males and 9 females, aged 3-49 years) with contracture scars causing impaired function of the adjacent joint were admitted to Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Eighteen joint scars of 16 patients were treated with fractional carbon dioxide laser every 2-3 months until the joint retained its normal range of motion or the effect plateaued. The treatment times of each patient were recorded. Before the first treatment and 6 months after the last treatment, the ranges of motion of the affected joint were measured in each patient, and the difference was calculated, meanwhile, the Vancouver Scar Scale (VSS) was used to evaluate the scar of each patient. In the treatment of 1 joint scar in each of 6 patients (totally 6 times of treatments), the ranges of motion of the affected joint before the current treatment, immediately after the treatment, and at the first follow-up after the treatment were documented, and the differences between the ranges before and immediately after the treatment as well as between the ranges before and at the first follow-up after the treatment were calculated. Adverse effects after the treatment in the treatment area were documented. At the last follow-up, a self-made questionnaire was used to collect the implementation status of the physical therapy and other scar management modalities during the treatment interval and follow-up period. Data were statistically analyzed with Wilcoxon rank sum test. Results: Eighteen joint scars in 16 patients received 2 (1, 3) times of fractional carbon dioxide laser treatment. The range of motion of the affected joint of 16 patients 6 months after the last treatment was 56.5 (39.0, 128.8)°, notably higher than 38.4 (22.9, 116.3)° before the first treatment (Z=-3.724, P<0.01), showing a remarkable improvement by 17.4 (8.0, 24.1)°. The vascular distribution, softness, and thickness scores, and total score in VSS scoring of scars of 16 patients 6 months after the last treatment were significantly lower than those before the first treatment (Z=-2.989, -3.762, -2.814, -3.739, P<0.01), with the most obvious improvement in softness. In 6 times of treatments, the range of motion of the affected joint immediately after treatment and at the first follow-up of (2.5±0.6) months after treatment were 156.2 (148.0, 164.2)° and 160.2 (156.7, 166.4)°, both notably higher than 151.4 (145.7, 155.3)° before treatment (Z=-2.201, -2.201, P<0.05), showing a remarkable improvement by 9.1 (4.4, 13.0)° and 13.1 (8.0, 15.7)°, respectively. No adverse effects such as blisters, infection, or hypertrophic scar formation were observed in the treatment area of 16 patients after treatment. Most patients adopted physical therapy, compression, silicone gel or sheets, and braces during the treatment interval and follow-up period. Conclusions: The fractional carbon dioxide laser can soften the scar and increase the range of motion of the affected joint, which is suitable for the clinical treatment of mild contracture scars.


Assuntos
Queimaduras , Cicatriz Hipertrófica , Contratura , Lasers de Gás , Dióxido de Carbono , China , Cicatriz/cirurgia , Cicatriz Hipertrófica/patologia , Contratura/etiologia , Contratura/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
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