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2.
Int J Biometeorol ; 64(12): 2195-2203, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32875343

RESUMO

Spa therapy is an integral part of the treatment of burn scars. The objective of this systematic review is to provide an overview of the spa therapy used in the treatment of burn scars and analyze its effects reported in clinical studies. We used the PRISMA checklist and queried 8 scientific databases from August 2019 to July 2020 for articles referenced with the specific key words: (burn) AND ((spa) OR (crenotherap*) OR (sulfur bath) OR (balneo*) OR (hydrotherap*) OR (mineral water) OR (thermal water) OR (spring water) OR (health resort medicine)). We used the EPHPP-QAT to assess the quality of the studies. Out of 10,050 publications identified in our database searches, 3 studies were selected: 2 clinical trials and 1 descriptive multicenter study that polled surgeons for their opinion on spa therapy for burn patients. All of the articles concluded that spa therapy is positive in burn scar recovery. No strong study on the effectiveness of spa therapy for burn scars care according to the EPHPP-QAT was identified. Spa therapy in the Saint Gervais spa center appears to be the only spa technique to have been evaluated for burn scar care. This review underscores the need to perform clinical studies to evaluate the effects and benefits of spa therapy for burn scars on patient's quality of life, and improve our understanding of the mechanisms of action of physiotherapy. Care programs should be harmonized in order to conduct multicenter studies.


Assuntos
Queimaduras , Cicatriz , Queimaduras/terapia , Cicatriz/terapia , Estâncias para Tratamento de Saúde , Humanos , Qualidade de Vida
3.
Zhonghua Fu Chan Ke Za Zhi ; 55(8): 516-520, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32854475

RESUMO

Objective: To explore the clinical value by analyzing the application of abdominal aortic balloon occlusion in the uterine curettage treatment for patients with cesarean scar pregnancy (CSP). Methods: Totally 42 CSP patients in the first Affiliated Hospital of Zhengzhou University were analyzed retrospectively, 21 cases in the observation group, placing the balloon catheter to the abdominal aorta under the renal artery under the digital substraction angiography(DSA), conducting curettage under hysteroscopy or uterine laparoscopy immediately, and making intermittent blockage in abdominal aorta blood flow during the surgery;21 patients in the control group, conducting uterine artery embolization (UAE) before operation, conducting curettage under hysteroscopy or uterine laparoscopy after 1-3 days. The fluoroscopy time under DSA, body surface radiation dose, intraoperative blood loss, operation time, incidence of postoperative adverse reactions, hospitalization time and follow-up menstruation were comparatively analyzed. Results: All patients operated and retained the uterus successfully. In the control group, all 21 patients had different degrees of fever, pain and other symptoms after UAE. In the observation group and control group, the fluoroscopy time and body surface radiation dose under DSA respectively were (7.4±1.4) s, (5.4±1.1) mGy and (1 142.8±315.5) s, (1 442.0±300.0) mGy (both P<0.01);the average amount of intraoperative blood loss were (22±15), (19±14) ml (P>0.05), the time of uterine curettage were (37±20), (42±19) minutes (P>0.05);hospitalization time were (5.0±0.9), (7.7±1.3) days (P<0.01). The follow-up period was more than 3 months, no adverse reactions were observed in the observation group; 4 cases of menstrual reduction and 1 case of intrauterine adhesions were found in the control group. Conclusion: Abdominal aortic balloon occlusion and UAE could effectively reduce intraoperative bleeding in uterine curettage for patients with CSP; abdominal aortic balloon occlusion has significant reduction of the X-ray dose, shorter hospitalization time, and fewer adverse events comparing to UAE.


Assuntos
Aorta Abdominal , Oclusão com Balão/métodos , Cicatriz/terapia , Embolização da Artéria Uterina/métodos , Oclusão com Balão/estatística & dados numéricos , Cesárea/efeitos adversos , Cicatriz/etiologia , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Embolização da Artéria Uterina/efeitos adversos , Embolização da Artéria Uterina/estatística & dados numéricos
4.
Medicine (Baltimore) ; 99(25): e20623, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569192

RESUMO

INTRODUCTION: Pathological scar is the abnormal manifestation of skin fiber hyperplasia caused by the failure of normal healing after skin damage. At present, there are many clinical treatments for pathological scars. However, there is no cure for clinically effective pathological scars with high recurrence rate. In this study, we will use a combination of Chinese and western medicine treatment methods to evaluate the clinical efficacy and related indicators of young and middle-aged female patients who meet pathological scars, looking for an objective and effective treatment method for pathological scars. METHODS/DESIGN: In this study, we will use our own front-to-back clinical research method. We plan to include 120 young and middle-aged female patients who meet the diagnostic criteria for pathological scars. The untreated pathological scars of the enrolled patients will be used as blank controls. The intervention group will be given conventional western medicine treatment and combined Chinese and western medicine treatment. The assessment of scar area, color, hardness, thickness, itching, and pain was recorded for 8 weeks of treatment. DISCUSSION: This trial may provide evidence regarding the clinical effectiveness, safety, and cost-effectiveness of traditional Chinese medicine for patients with pathological scars. TRIAL REGISTRATION: ClinicalTrials.gov, ChiCTR2000032187, Registered on April 22, 2020.


Assuntos
Cicatriz/terapia , Medicina Tradicional Chinesa/métodos , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
5.
Rev. argent. cir. plást ; 26(2): 68-75, apr-jun 2020. tab, fig
Artigo em Espanhol | LILACS | ID: biblio-1120092

RESUMO

Introducción. Las retracciones cicatrizales secundarias a quemaduras representan un desafío para el cirujano plástico debido a la variabilidad en su complejidad y presentación. La pérdida de movimiento del codo conlleva una limitación funcional con impacto directo en la calidad de vida, por lo que la indicación quirúrgica se hace necesaria. La gran variedad de tácticas quirúrgicas plantean la necesidad de sistematizar el tratamiento de las retracciones cicatrizales. Objetivo. El objetivo de esta presentación es la aplicación de la sistemática en el tratamiento de la secuela posquemadura de codo en el Servicio de Cirugía Plástica del Hospital de Quemados del Gobierno de la Ciudad de Buenos Aires durante los últimos 10 años. Material y métodos. Mediante un diseño observacional, descriptivo y retrospectivo, se realizó el presente trabajo sobre pacientes con diagnóstico de retracción cicatrizal posuemadura en codo de agosto de 2008 a agosto de 2018. El criterio de inclusión fue pacientes entre 3 y 65 años sometidos a cirugías reconstructivas para la liberación de contracturas del codo posteriores a una quemadura durante el período mencionado. Se realizó una revisión de las historias clínicas y se evaluaron los casos a través del examen físico y de documentación fotográfica, y se analizaron diferentes variables: sexo, edad, comorbilidades, clasificación de gravedad, grado de retracción pre- y posoperatoria, tipo de reconstrucción empleada y complicaciones. Las variables mencionadas se registraron en tablas. Resultados. Treinta y cuatro pacientes operados, 20 mujeres y 14 hombres. El rango de edad fue de 3 hasta los 50 años, con una media de 21,2 años. La causa más frecuente de quemadura fue el agua caliente. El grado de retracción fue leve en 41,17% (14 casos), moderada en 47,05% y severa en 11,7%. El procedimiento más utilizado fueron los colgajos pediculados (50%), seguido por los colgajos locales (41,2 %) y, por último, se emplearon injertos de piel (8,8%). Dentro de los colgajos pediculados, el más utilizado fue el colgajo antecubital (12 casos) con un 70,6%, seguido por el colgajo braquial lateral con un 23,5% y, por último, con un solo caso, un colgajo propeller, que representó el 5,9%. Dentro de las plásticas locales, los colgajos de avance representaron el 42,8%, seguidos por las zetaplastias en un 35,7%, los colgajos de transposición en un 14,3% y la w plastia en un 7,14%. Todos los injertos de piel realizados fueron de espesor total. Las complicaciones fueron dehiscencia del borde del colgajo y epidermólisis. La ganancia objetiva de extensin en grados fue entre 5 y 80 grados. Conclusiones. Podemos concluir que es posible la aplicación de nuestro algoritmo para el tratamiento en la secuela cicatrizar en codo. Siempre que sea posible, se recomienda utilizar un colgajo fasciocutáneo por su mejor cobertura, resistencia y poca morbilidad de obtención. Todo método quirúrgico debe acompañarse con medidas no quirúrgicas como la ferulización y la rehabilitación kinésica temprana para lograr un resultado sostenido en el tiempo.


Introduction. Burn injuries to the elbow can lead to significant functional impairment and major aesthetic problems. This represents a challenge for the plastic surgeon due to the variability in their complexity and presentation. The elbow can be constructed with a wide range of surgical technique such as skin grafts, local, regional or free flaps. However, contractures vary greatly, depending on the loss of function, depth and extension of tissue involvement, and duration of scarring and, therefore, surgical intervention should be tailored for each patient. Objective. To present our experience and systematic approach for releasing postburn elbow contractures. Materials and methods. A retrospective review of the cases of post-burn elbow contractures treated in our center between August of 2008 and August of 2018 was conducted. Results. Since 2008 we have treated 34 patients. They included 20 female patients and 14 male patients. The average age was 21,2 years (range 3-50 years) at the time of the first corrective operation. Severity of elbow contracture was graded as mild in 41,17% of the cases, moderate in 47,05% and severe in 11,7%. Contractures were treated with fascio cutaneous pedicled flaps in 50% of the cases, with local flaps in 41,2% of the cases and with skin graft in 8,8%.Of the fascio cutaneous flaps employed, 12 patients were treated with an antecubital flap, 4 with a lateral arm flap and 1 with a propeller flap. Among the local flaps, z plasties and advancement flaps were the most commonly used. Elbow excursion improved in all cases between 5 and 80 degrees Conclusions. Severe elbow contracture resulting from burn injury can be treated using a systematic approach according to the physical characteristics of the contracture. Although there are many techniques of soft-tissue coverage to treat elbow contractures, we advocate using well-vascularized fascio cutaneous flaps to provide coverage due to their resistance and low donor site morbidity.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Algoritmos , Queimaduras/terapia , Cicatriz/terapia , Transplante de Pele , Procedimentos Cirúrgicos Reconstrutivos
6.
Cir. plást. ibero-latinoam ; 46(2): 233-240, abr.-jun. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-194728

RESUMO

INTRODUCCIÓN Y OBJETIVO: La micropigmentación de cejas es un conocido procedimiento para mejorar las cejas envejecidas y las jóvenes y también para crearles una forma estética. A pesar de la evolución de la aparatología y de las rutinas para llevar a cabo este procedimiento, existe una carencia de productos que favorezcan la cicatrización y protección tanto de la piel como para el uso de nuevos pigmentos. Durante muchos años el empleo de dermocosméticos comunes con vitamina C en este procedimiento no ha estado indicado por la posibilidad de blanqueamiento y decoloración, a pesar de sus reconocidas propiedades antioxidantes y de cicatrización. En este estudio nos proponemos investigar si es posible adicionar vitamina C nanoencapsulada en el procedimiento de micropigmentación de las cejas para obtener ventaja de sus propiedades y mejorar los resultados, y si su forma nanoencapsulada puede obtener mejores resultados sin el blanqueamiento o la decoloración que parecen provocar otros dermocosméticos comunes con vitamina C. MATERIAL Y MÉTODO: Realizamos un estudio prospectivo y randomizado que incluyó 31 pacientes sometidas a micropigmentación bilateral de cejas utilizando el mismo procedimiento de rutina y el mismo aparato de micropigmentación. Bajo su consentimiento, las pacientes fueron sus propios controles y recibieron vitamina C nanoencaspulada en una ceja y rutina de micropigmentación normal en la otra. RESULTADOS: La evaluación se realizó mediante documentación fotográfica y análisis visual, valorando si hubo o no pérdida del color. La ceja derecha, tratada con vitamina C nanoencapsulada, mostró mejores resultados que el control, manteniendo los pigmentos y la forma con resultados claramente superiores (70.97%). La ceja izquierda, no tratada, mostró mejores resultados en solo el 22.58% de las pacientes. CONCLUSIONES: Los resultados fueron satisfactorios y abren una nueva visión sobre el papel de la vitamina C nanoencapsulada en la cicatrización y protección de la piel en el procedimiento de micropigmentación de las cejas


BACKGROUND AND OBJECTIVE: Eyebrows micropigmentation is a popular procedure to enhance the aged and youth eyebrows and to create an aesthetic shape to them. Despite the devices evolution and routines for this procedure there is a lack of wound healing and protection products both to skin and the new pigments. For many years, the use of regular Vitamin C dermocosmetics in this procedure has been non indicated, because the possibility of whitening and discoloration, despite its recognized wound healing and antioxidants properties. Our propose in this paper is to investigate if it's possible to add nanoencapsulated vitamin C in eyebrows micropigmentation procedure in order to take advantage of its properties, to enhance the procedure results, and if the nanoencapsulated vitamin C can get better results in eyebrows micropigmentation, without whitening and discoloration METHODS: A prospective randomized study was developed including 31 patients who underwent bilateral eyebrows micropigmentation using the same procedure routine and device. Under their consent, patients served as their own control and received nanoencapsulated vitamin C to one eyebrow and none product to the other side. RESULTS: The evaluation was carried out using photographic documentation and visual analysis, assessing whether or not there was color loss. The right eyebrow, treated with nanoencapsulated vitamin C showed better results than the control, maintaining pigments and shape with clearly superior results (70.97%). The untreated left eyebrow showed better results in only 22.58% of patients. CONCLUSIONS: The results were satisfactory and open a new vision on the role of nanoencapsulated vitamin C in the healing and protection of the skin in the micropigmentation procedure of the eyebrows


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Nanocápsulas/administração & dosagem , Ácido Ascórbico/administração & dosagem , Sobrancelhas , Tatuagem/métodos , Pigmentação da Pele , Cicatriz/terapia , Procedimentos Cirúrgicos Dermatológicos/métodos , Cicatrização/efeitos dos fármacos , Estudos Prospectivos
7.
Khirurgiia (Mosk) ; (4): 53-60, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32352669

RESUMO

Development of tracheal surgery was associated with introduction of fundamentally new procedures: two-level reconstruction, redo tracheal resection, tracheal resection with simultaneous dissection of tracheoesophageal fistula. There are combined and staged techniques when tracheal repair or endoscopic interventions are performed as a stage before circular resection of trachea. However, a single algorithm for prevention and correction of postoperative complications is still absent in tracheal surgery. Further development of tracheal surgery directly depends on introduction of preventive measures and analysis of adverse factors associated with increased risk of complications. In this regard, ongoing researches in this area are very perspective.


Assuntos
Traqueia/cirurgia , Estenose Traqueal/cirurgia , Cicatriz/diagnóstico , Cicatriz/etiologia , Cicatriz/terapia , Constrição Patológica/cirurgia , Dissecação , Humanos , Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal/diagnóstico , Estenose Traqueal/etiologia , Estenose Traqueal/patologia , Fístula Traqueoesofágica/etiologia , Fístula Traqueoesofágica/cirurgia , Traqueotomia
8.
Zhonghua Shao Shang Za Zhi ; 36(5): 357-362, 2020 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-32456372

RESUMO

Objective: To explore the effect of combined application of pulsed dye laser (PDL) and ultra-pulsed fractional carbon dioxide laser (UFCL) in the treatment of pediatric large burn scars at early stage. Methods: One hundred and twenty pediatric patients with large burn scars at early stage conforming to the study criteria were admitted to the People's Hospital of Hunan Province from January 2016 to December 2019. Their data were retrospectively analyzed by the method of single case-control study. There were 78 males and 42 females with age of (4.2±0.8) years and scar area of (100.3±0.7) cm(2). PDL combined with UFCL was used for the first time. The treatment interval of PDL was a month and the treatment interval of UFCL was 3 months. The total treatment cycle was 6 months, with 2 PDL treatments alone and two combined treatments. Before the first combined treatment and 6 months after two combined treatments, the curative effect was assessed using Patient and Observer Scar Assessment Scale (POSAS) by doctors and family members of pediatric patients. Satisfaction degrees of the family members of pediatric patients were recorded, and the overall satisfaction rate was calculated 6 months after two combined treatments. The adverse effects during the whole treatment course were recorded. Data were statistically analyzed with paired t test. Results: (1) Six months after two combined treatments, the scores of pediatric patients' scar vascularity, pigment, thickness, relief, pliability, surface area, and overall valuation in POSAS by doctors and the scores of pain, itch, color, stiffness, thickness, irregularity, and overall valuation in POSAS by family members of pediatric patients were all significantly lower than those before the first combined treatment (t=16.6, 16.0, 16.9, 14.9, 20.8, 29.3, 30.7, 20.4, 29.3, 18.1, 27.9, 25.8, 20.8, 45.3, P<0.01). The overall evaluation scores by doctors were (8.1±0.8) and (2.7±0.6) points, and the overall evaluation scores by family members of pediatric patients were (8.2±0.8) and (2.4±0.5) points respectively before the first combined treatment and six months after two combined treatments. (2) Six months after two combined treatments, 110 (92%) family members of pediatric patients were very satisfied with the curative effect, 6 (5%) family members of pediatric patients were satisfied, and 4 (3%) family members of pediatric patients were relatively satisfied with no unsatisfied reported. The overall satisfaction rate was 97% (116/120). (3) During the treatment, pruritus and rash appeared in 5 pediatric patients 3 to 4 days after the first treatment; pigmentation appeared in 3 pediatric patients 3 weeks after the first treatment; pruritus and vesicle appeared in 1 patient 1 week after the third treatment. No adverse effects such as aggravated scar or infection were observed on the wounds. Conclusions: In treating pediatric large burn scars at early stage, PDL combined with UFCL has demonstrated significant effect with short treatment cycle, few adverse effects. The combined treatment can alleviate symptoms and improve the quality of pediatric patients' life, and is worthy to be popularized and applied in clinic.


Assuntos
Queimaduras/complicações , Cicatriz/terapia , Lasers de Corante , Lasers de Gás , Queimaduras/terapia , Estudos de Casos e Controles , Pré-Escolar , Cicatriz/etiologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
9.
Zhonghua Shao Shang Za Zhi ; 36(5): 363-369, 2020 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-32456373

RESUMO

Objective: To explore the clinical effect of pre-expanded deltopectoral flap in the repair of faciocervical lesion and defect. Methods: From July 2004 to August 2018, 355 patients with faciocervical lesion and defect were admitted to the First Affiliated Hospital of Air Force Medical University, including 200 males and 155 females aged 4 to 48 years with major conditions including thermal burn scars, and type Ⅲ and Ⅳ facial-cervical deformities. During the stage Ⅰ skin soft tissue expander implantation surgery, according to the size and location of lesion and defect, expanders with appropriate volume were placed to expand the deltopectoral area. During the stage Ⅱ flap pedicled transposition surgery, after the expander was expanded to the desired volume, the impairment tissue was removed, the flap was designed according to the size of the defect (the unilateral defect area was 7 cm×5 cm to 17 cm×16 cm) and pedicled transposition was carried out. The incision in the chest donor area was directly sutured and closed. After the flap survived, stage Ⅲ flap delay and pedicle division surgery was carried out. The area of one single flap was 8 cm×5 cm to 20 cm×18 cm. The numbers of flaps and expanders, rated volume and expansion of expander, the intervals between surgeries in each stage, flap survival, postoperative complications in surgeries in each stage, and follow-up were recorded and analyzed. Results: A total of 460 pre-expanded deltopectoral flaps were used, including 250 unilateral flaps and 105 bilateral flaps. Totally 460 expanders were used in this group of patients. The rated volume was mostly 500 mL (163 expanders) and 600 mL (142 expanders). The expansion multiple of the expander was (1.14±0.19) times of the rated volume. The flap expansion time of the patients was (96±30) d, the pedicle time was (32±8) d, and the delay time was (7.5±1.6) d. The postoperative complications of patients mainly included infection (29 patients), expander exposure (18 patients), and hematoma (10 patients). During the follow-up of 6 to 120 months, the elasticity, texture, and color of the flaps of patients were similar to the surrounding tissue of the recipient area, and the face and neck were symmetrical, not bloated. Conclusions: The deltopectoral flap obtained by overexpansion has a larger area and a thinner thickness, and the elasticity, texture, and color are similar to the surrounding tissue of the recipient area. After transfer, a stable appearance of the face and neck can be obtained. The main complications are infection and expander exposure, most of which occurred after stage Ⅰ skin soft tissue expander implantation surgery.


Assuntos
Queimaduras/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele , Retalhos Cirúrgicos , Adolescente , Adulto , Criança , Pré-Escolar , Cicatriz/etiologia , Cicatriz/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Expansão de Tecido , Adulto Jovem
10.
Zhonghua Shao Shang Za Zhi ; 36(3): 210-218, 2020 Mar 20.
Artigo em Chinês | MEDLINE | ID: mdl-32241047

RESUMO

Objective: To explore the clinical effects of concentrated growth factor (CGF) combined with plasma albumin gel (PAG) in treating facial depressed scar. Methods: From January 2018 to June 2019, 14 patients in the First Affiliated Hospital of Zhengzhou University and 10 patients in Henan NO.3 Provincial People's Hospital with facial depressed scar who met the inclusion criteria were admitted, and their clinical data were retrospectively analyzed by the method of case-control study. Based on the method of treatment, 8 patients (4 males and 4 females) aged 28.50 (25.50, 31.50) years were enrolled in CGF alone group, 8 patients (3 males and 5 females) aged 32.00 (28.50, 35.00) years were enrolled in PAG alone group, and 8 patients (5 males and 3 females) aged 33.50 (29.00, 35.75) years were enrolled in CGF+ PAG group. Suitable amount of CGF, PAG, and CGF+ PAG (mixed at a ratio of 1.0∶1.0-1.0∶1.5) prepared from autologous blood were injected subcutaneously via a single or multiple entrance (s) into the depressed scar of patients in CGF alone, PAG alone, and CGF+ PAG groups respectively to fill up the concavity, once every 4 weeks for a total of 3 times. Before the first treatment (hereinafter referred to as before treatment) and 3 months after the last treatment (hereinafter referred to as after treatment), the Goodman & Baron Acne Scar Grading System was used for scar grading, and the difference was calculated; the Anxiety Self-Rating Scale was used to score anxiety, and the difference was calculated. The Visual Analogue Score was used to score pain immediately after the first treatment. By one, two, and three months after treatment, the patients' satisfaction to scar treatment was scored, and the Global Aesthetic Improvement Scale was used to score the scar improvement. Adverse reaction of patients after treatment was monitored. Data were statistically analyzed with Fisher's exact probability test, Kruskal-Wallis H test, Mann-Whitney U test, Bonferroni correction, and Wilcoxon signed rank sum test. Results: (1) The scars of patients in the three groups were all graded 4.00 (4.00, 4.00) before treatment (χ(2)<0.001, P>0.05). By three months after treatment, compared with 2.00 (1.25, 2.00) of CGF alone group, the scar grades of patients in PAG alone group and CGF+ PAG group (3.00 (2.00, 3.00) and 1.00 (1.00, 1.00), respectively) had no significant change (Z=2.199, 2.003, P>0.05). The scar grade of patients in CGF+ PAG group was significantly lower than that in PAG alone group (Z=3.229, P<0.01). Compared with those before treatment, the scar grades of patients in CGF alone group, PAG alone group, and CGF+ PAG group were significantly reduced three months after treatment (Z=2.588, 2.598, 2.640, P<0.05 or P<0.01). The difference in scar grade before and after the treatment was significantly higher in CGF+ PAG group than in PAG alone group (Z=3.229, P<0.01). (2) The anxiety scores of patients in the three groups were similar before treatment and 3 months after (χ(2)=2.551, 2.768, P>0.05). Compared with those before treatment, the anxiety scores of patients in CGF alone group, PAG alone group, and CGF+ PAG group were significantly reduced three months after treatment (Z=2.395, 2.527, 2.533, P<0.05). The differences in anxiety score before and after the treatment were similar among the three groups (χ(2)=1.796, P>0.05). (3) The pain scores of patients in the three groups were similar immediately after the first treatment (χ(2)=0.400, P>0.05). (4) By one and two month (s) after treatment, the patients' satisfaction scores to scar treatment in the three groups were similar (χ(2)=2.688, 5.989, P>0.05). By three months after treatment, the patients' satisfaction score to scar treatment in CGF+ PAG group was significantly higher than that in PAG alone group (Z=2.922, P<0.01). Compared with those one month after treatment within the same group, the patients' satisfaction scores to scar treatment in CGF alone group, PAG alone group, and CGF+ PAG group were significantly increased two and three months after treatment (Z=1.121, 2.392, 2.000, 2.828, 2.449, 2.598, P<0.05 or P<0.01). Compared with those two months after treatment within the same group, the patients' satisfaction scores to scar treatment in CGF alone group, PAG alone group, and CGF+ PAG group were significantly increased three months after treatment (Z=2.271, 2.000, 2.646, P<0.05 or P<0.01). (5) One month after treatment, the scar improvement scores of patients in the three groups were similar (χ(2)=4.438, P>0.05). Two months after treatment, the scar improvement scores of patients in CGF alone group and CGF+ PAG group were 2.00 (2.00, 2.75) and 2.00 (2.00, 2.00) points, respectively, which were significantly higher than 1.00 (1.00, 1.00) point of PAG alone group (Z=3.303, 3.771, P<0.01). Three months after treatment, the scar improvement score of patients in CGF+ PAG group was 3.00 (3.00, 3.00) points, which was significantly higher than 2.00 (2.00, 2.75) points of CGF alone group and 1.00 (1.00, 2.00) points of PAG alone group (Z=2.450, 3.427, P<0.05 or P<0.01). Compared with those one month after treatment within the same group, the scar improvement scores of patients were significantly higher in CGF alone group and CGF+ PAG group two and three months after treatment and in PAG alone group three months after treatment (Z=2.828, 2.828, 2.530, 2.640, 2.121, P<0.05 or P<0.01). Compared with that two months after treatment within the same group, the scar improvement score of patients in CGF+ PAG group was significantly higher three months after treatment (Z=2.449, P<0.05). (6) After injection, all patients in the three groups had slight redness and swelling at the needle prick point and no other adverse reactions. Conclusions: CGF combined with PAG can reduce the scar grading, anxiety of patients, and enhance patients' satisfaction and scar improvement in the treatment of patients with facial depressed scar. The combined CGF+ PAG injection, without significant adverse reactions, is better than single component injection and is worthy of clinical application.


Assuntos
Queimaduras/complicações , Cicatriz/terapia , Géis/uso terapêutico , Albumina Sérica/uso terapêutico , Adulto , Queimaduras/terapia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Satisfação do Paciente , Estudos Retrospectivos , Resultado do Tratamento
11.
Plast Reconstr Surg ; 145(4): 734e-743e, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221207

RESUMO

BACKGROUND: Long-term aesthetic reduction of the legs in Asians is gaining increasing popularity among cosmetic patients. Current treatment options include botulinum toxin injection, radiofrequency, neurectomy, and total, subtotal, or partial muscle resection of the gastrocnemius. Partial resection using Kelly forceps was introduced in 2000. This article presents the use of a suction-assisted cartilage shaver to perform partial resection, describing the procedures and shaver modifications and evaluating its use. METHODS: A retrospective review of 71 cases with a minimum 6-month follow-up (average, 36.5 months; range, 6 to 160 months) was performed. Twenty partial calf reductions were performed with a short shaver, 27 with a long shaver, and 24 with an endoscope-guided long shaver. RESULTS: Mean reduction of calf circumference was 2 cm (range, -1 to 6 cm); the mean preoperative and postoperative calf circumferences were 35.8 cm and 33.8 cm, respectively. Mean tissue reduction per calf was 110 g (range, 25 to 300 g).Two patients developed larger calves after surgery, one because of weight gain and the other because of weight training. Complications included surface irregularity (n = 4, 5.6 percent), numbness over the lateral ankle or lateral foot (n = 9, 12.7 percent), hematoma clot requiring surgical evacuation (n = 11, 15.5 percent), prolonged seroma (n = 2, 2.8 percent), and left ankle plantar-flexion contracture due to tight, sustained postsurgery bandaging (n = 1, 1.5 percent). Scar-related complications were hyperpigmentation (n = 6, 8.5 percent), depressed scars (n = 5, 7 percent), and hypertrophic scars (n = 2, 2.8 percent). CONCLUSIONS: Short, long, and endoscope-guided long suction-assisted cartilage shavers for partial resection of calf muscles can be used effectively to reduce the calf. Several mostly treatable complications were noted. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Contorno Corporal/instrumentação , Endoscopia/instrumentação , Músculo Esquelético/cirurgia , Miotomia/instrumentação , Complicações Pós-Operatórias/epidemiologia , Adulto , Contorno Corporal/efeitos adversos , Contorno Corporal/métodos , Cicatriz/epidemiologia , Cicatriz/etiologia , Cicatriz/terapia , Contratura/epidemiologia , Contratura/etiologia , Contratura/terapia , Endoscopia/efeitos adversos , Endoscopia/métodos , Estética , Feminino , Seguimentos , Hematoma/epidemiologia , Hematoma/etiologia , Hematoma/terapia , Humanos , Hiperpigmentação/epidemiologia , Hiperpigmentação/etiologia , Hiperpigmentação/terapia , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Miotomia/efeitos adversos , Miotomia/métodos , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Seroma/epidemiologia , Seroma/etiologia , Seroma/terapia , Sucção/efeitos adversos , Sucção/instrumentação , Sucção/métodos , Adulto Jovem
12.
J Am Acad Orthop Surg ; 28(10): e408-e414, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32109921

RESUMO

Keloid and hypertrophic scar formation after orthopaedic surgical closure is a complex issue. The nature and location of procedures maximize wound tension, leave foreign bodies, and diminish dermal supply, all potentiating keloid formation. There is little discussion regarding the pathophysiology and management of this recurrent problem in orthopaedic literature. Keloid formation is a fibroproliferative disorder resulting in extensive production of extracellular matrix and collagen, but prevention and treatment is poorly understood. Patient and surgical factors contributing to the development of this condition are discussed. The treatments include both medical and surgical therapies that work at a biologic level and attempt to produce a cosmetic and complication-free management strategy. Medical options that have been investigated include combinations of intralesional steroid therapy, laser therapy, and biologics. Preventive surgical closure and excision remain mainstays of treatment. Radiation therapy has also been used in refractory cases with mixed results. Despite medical therapies and surgical excision aimed at treating the resulting scar, recurrence rate is very high for all modalities that have been studied to this point. Future work is being done to better understand the pathophysiology leading to keloid and hypertrophic scar formation in an effort to find preventive methods as compared to treatment strategies.


Assuntos
Cicatriz/prevenção & controle , Cicatriz/terapia , Queloide/prevenção & controle , Queloide/terapia , Cicatriz/etiologia , Cicatriz/patologia , Glucocorticoides/administração & dosagem , Humanos , Queloide/etiologia , Queloide/patologia , Terapia a Laser , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Radioterapia , Recidiva
13.
Eur J Pharm Biopharm ; 148: 54-66, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31945489

RESUMO

A variety of hepatic insults result in the accumulation of collagen-rich new extracellular matrix in the liver, ultimately culminating in liver fibrosis and cirrhosis. For such reasons, approaches looking into digestion of the collagen-rich extracellular matrix present an interesting therapeutic approach for cases of chronic liver disease, where the fibrotic scar is well established. Portal collagenase administration has recently led to the successful reversion of cirrhosis in an experimental rabbit model. Notwithstanding, the question of how such a sensitive therapeutic macromolecule could be administered in a less invasive manner, and in a way that preserves its functionality and avoids digestion of other non-hepatic vital collagen presents itself. Chitosan is a biodegradable polymer that has been reported to interact and bind to collagen. Chitosan nanoparticles (CS NPs) have also been reported to encapsulate therapeutic proteins, maintaining their functional form and protecting them from in-vivo degradation. For such reasons, CS NPs were loaded with collagenase and evaluated in-vitro and in-vivo for their ability to target and digest collagen. CS NPs were able to encapsulate collagenase (≈ 60% encapsulation efficiency) and release its content in active form. To determine whether chitosan's collagen interaction would enable NP collagen binding or whether the modification with collagen binding peptides (CBPs) is necessary, CS NPs were modified with the CBP; CCQDSETRTFY. Since the density of targeting ligand and the length of tether play a significant role in the success of active targeting, the surface of NPs was modified with different densities of the CBP either directly or using a polyethylene glycol (PEG) spacer. PEGylated NPs showed higher levels of CBP tagging; high, intermediate and low density of CBPs corresponded to 585.8 ± 33, 252.9 ± 25.3 and 56.5 ± 8.8 µg/mL for PEGylated NPs and 425.56 ± 12.67, 107.91 ± 10.3 and 49.86 ± 3.2 µg/mL for unPEGylated NPs, respectively. In-vitro collagen binding experiments showed that unmodified CS NPs were able to bind collagen and that modification with CBPs either directly or via PEG did not enhance collagen binding. In-vivo experiments demonstrated that unmodified CS NPs were able to reverse fibrosis with a survival rate of 100% at the end of the study, indicating the ability of CS NPs to deliver functional collagenase to the fibrotic liver and making the use of CBPs unnecessary.


Assuntos
Quitosana/química , Cicatriz/terapia , Colagenases/administração & dosagem , Cirrose Hepática/terapia , Animais , Cicatriz/patologia , Colágeno/metabolismo , Colagenases/farmacologia , Portadores de Fármacos/química , Sistemas de Liberação de Medicamentos , Cirrose Hepática/patologia , Masculino , Camundongos , Nanopartículas , Polietilenoglicóis/química
14.
J Craniofac Surg ; 31(2): e214-e217, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31977699

RESUMO

BACKGROUND: Appearance and beauty always have been playing a major aspect of human's lives, regardless of the era. The desire for man to look better had led to various treatment modalities. One among them is microneedling therapy, also called as percutaneous collagen induction therapy or dermaroller therapy. Henceforth, the aim of the study was to evaluate the efficacy of microneedling therapy in the management of facial scars. METHODS: An observational clinical study was conducted with a total of 14 patients who needed treatment and presented to the out-patient department of Department of Oral and Maxillofacial Surgery. The patients who were cooperative, motivated, and esthetically conscious with facial scars due to trauma, soft-tissue injury following incision and drainage, postsurgical scars, scars following surgery of cleft lip correction, and postacne scars were randomly selected. RESULTS: In the present study, a statistically significant difference was observed with pre- and postsurgical patient satisfaction scale (PSS) and observed satisfaction scale (OSS; P = 0.001). Preoperatively there were 64.3% with depressed scars and 35.7% with elevated scars. The clinical response of height of scar postoperatively was 100% flattening with the surrounding skin surface. Results showed that all atrophic and hypertrophic scars showed improvement, and color of the scar which was darker or lighter than the surrounding skin got the same color as the surrounding skin after microneedling therapy. Pain during the procedure was easily tolerable by the patient and no postoperative pain was noted. CONCLUSION: Microneedling therapy can be considered as an effective modality of treatment for facial scars in patients with an added advantage of minimal downtime and effective improvement. It is simple and cost-effective technique in the treatment of facial scars.


Assuntos
Cicatriz/terapia , Agulhas , Adolescente , Adulto , Atrofia , Cicatriz/patologia , Cicatriz Hipertrófica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor , Pele/patologia , Adulto Jovem
15.
Int J Mol Sci ; 21(2)2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31963533

RESUMO

Scarring and regeneration are two physiologically opposite endpoints to skin injuries, with mammals, including humans, typically healing wounds with fibrotic scars. We aim to provide an updated review on fibroblast heterogeneity as determinants of the scarring-regeneration continuum. We discuss fibroblast-centric mechanisms that dictate scarring-regeneration continua with a focus on intercellular and cell-matrix adhesion. Improved understanding of fibroblast lineage-specific mechanisms and how they determine scar severity will ultimately allow for the development of antiscarring therapies and the promotion of tissue regeneration.


Assuntos
Cicatriz/terapia , Derme/citologia , Fibroblastos/citologia , Regeneração , Pele/citologia , Cicatrização , Animais , Cicatriz/patologia , Humanos
16.
Plast Reconstr Surg ; 145(2): 358-364, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31985622

RESUMO

BACKGROUND: In recent years, microneedling has been increasingly used to treat a number of dermatologic conditions, including scars. Although initial studies demonstrated improvement of (mostly) atrophic scars with microneedling, the number of patients evaluated was relatively small, and the devices and treatment protocols used and posttreatment follow-up varied widely. Through this prospective observational study, the results of microneedling on 120 patients with a variety of scars are described. METHODS: One hundred twenty consecutive patients (skin phototypes I through VI) with facial and nonfacial scars from a variety of etiologic sources (acne, trauma, surgery) were treated using a mechanical microneedling device. No additional treatments (topical or intralesional) were applied. Two assessors blinded to treatment protocol rated clinical improvement of scars 1, 3, 6, and 12 months after treatment on a five-point scale. Side effects were monitored and tabulated. RESULTS: Patients received one to six consecutive monthly microneedling treatments. All scars improved at least 50 percent after an average of 2.5 treatments. Over 80 percent of patients had 50 to 75 percent improvement, and 65 percent of patients demonstrated over 75 percent improvement. No significant clinical differences were observed in treatment responses of facial scars versus nonfacial scars nor between responses of atrophic acne scars and traumatic or surgical scars. CONCLUSIONS: This study supports the use of microneedling for various facial and nonfacial scars across a broad range of skin phototypes with minimal risk of adverse effects. Further studies will help to establish standardized protocols to optimize treatment outcomes for different scar types. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Cicatriz/terapia , Técnicas Cosméticas/instrumentação , Agulhas , Adolescente , Adulto , Idoso , Dermatoses Faciais/terapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
17.
Dermatol Surg ; 46(1): 86-92, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31356435

RESUMO

BACKGROUND: Microneedling is a popular, minimally invasive skin rejuvenation modality for acne scarring. Recent reports have evaluated the efficacy and safety of microneedling monotherapy and combination treatment for scarring. OBJECTIVE: This review aims to systematically analyze the current literature on microneedling techniques used for acne scarring. METHODS: A PubMed search (2009-current) was used to identify literature on microneedling treatment for acne. All randomized and nonrandomized clinical trials, case cohorts, case reports, and case series were included with the exception of 2 studies, which were excluded due to unavailability. RESULTS: All 33 articles evaluated showed improvement of acne scar appearance after microneedling treatment. Evidence was inconsistent when comparing microneedling monotherapy to dual therapy or to fractional laser treatment. CONCLUSION: Microneedling improves acne scarring, and further studies are needed to compare microneedling with other minimally invasive treatments.


Assuntos
Acne Vulgar/complicações , Acne Vulgar/terapia , Cicatriz/etiologia , Cicatriz/terapia , Técnicas Cosméticas , Humanos , Agulhas , Resultado do Tratamento
18.
J Cosmet Dermatol ; 19(1): 115-121, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31141299

RESUMO

BACKGROUND: Acne scars lead to social and psychological problems for patients, and they should be treated effectively. Ablative and nonablative lasers have been used for the treatment of acne scars in recent years. AIMS: The aim of this study was to evaluate the effectivity of combined FCL and FmRF treatment for acne scars retrospectively. METHODS: A total of 72 patients with acne scars who received FCL + FmRF treatment between 2014 and 2016 were included in this study. Photographs of patients before treatment and 1 month following the last treatment session were scored by two blinded researchers, according to the ECCA acne scar scoring method. Patients were contacted via telephone after 1 month following the last treatment and asked to evaluate their satisfaction with the treatment outcome using a 5-point Likert-type scale. RESULTS: A significant decrease was noted in ECCA scores after the treatment along with temporary side effects. Change from pretreatment scores was significantly higher in patients very satisfied vs satisfied with treatment. The number of treatment sessions was positively correlated with treatment-related change in ECCA scores. CONCLUSIONS: In conclusion, our findings revealed association of FCL + FmRF treatment with significantly improved ECCA scores, mild pain experience, and low rate of side effects in patients with acne scars, despite usage of high-energy FLC dose and five sessions of treatment on average. More remarkable improvement in ECCA scores during treatment seems to be associated with higher patient satisfaction and to be more likely in patients with darker skin types.


Assuntos
Acne Vulgar/complicações , Cicatriz/terapia , Lasers de Gás/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Terapia por Radiofrequência/métodos , Adulto , Cicatriz/etiologia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Feminino , Humanos , Terapia com Luz de Baixa Intensidade/efeitos adversos , Terapia com Luz de Baixa Intensidade/instrumentação , Masculino , Agulhas/efeitos adversos , Medição da Dor , Dor Processual/diagnóstico , Dor Processual/etiologia , Satisfação do Paciente , Terapia por Radiofrequência/efeitos adversos , Terapia por Radiofrequência/instrumentação , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
J Cosmet Dermatol ; 19(2): 456-461, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31241854

RESUMO

BACKGROUND: Multiple therapeutic approaches are usually required when treating atrophic acne scars. Subcision was reported to be of value in improving rolling scars. Autologous platelet-rich plasma (PRP) has recently been proposed as an adjuvant treatment option for atrophic acne scars with few reports evaluating its efficacy. OBJECTIVE: Our objective was to compare the effect of intradermal injection of PRP vs combined PRP and subcision in the treatment of atrophic acne scars. METHODS: Thirty patients with bilateral atrophic acne scars were enrolled. Each patient received three monthly sessions. Each side of the face was randomly treated either with intradermal PRP alone or with combined treatment with subcision followed by PRP injection. Patients were assessed at 3 and 6 months following the last treatment session. Evaluation of serial photographs was performed by two blinded investigators. RESULTS: Platelet-rich plasma alone showed a better response, fewer side effects, and shorter downtime compared to combined subcision and PRP. CONCLUSION: Autologous PRP injection can be a therapeutic option in the treatment of atrophic acne scars, with fewer complications and better tolerability than combined subcision and autologous PRP.


Assuntos
Acne Vulgar/terapia , Transfusão de Sangue Autóloga/métodos , Cicatriz/terapia , Técnicas Cosméticas/instrumentação , Plasma Rico em Plaquetas , Acne Vulgar/complicações , Adolescente , Adulto , Atrofia/etiologia , Atrofia/terapia , Cicatriz/etiologia , Terapia Combinada/métodos , Feminino , Seguimentos , Humanos , Injeções Intradérmicas , Masculino , Agulhas , Satisfação do Paciente , Resultado do Tratamento , Adulto Jovem
20.
J Cosmet Dermatol ; 19(1): 112-114, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31070298

RESUMO

A common complication of acne vulgaris is clinically significant scarring, which can greatly impact patient quality of life. While treatment options have included microneedling, the recent addition of platelet-rich plasma (PRP) to this regimen has led to an increased popularity of combination treatment. Here, we offer backgrounds on microneedling and PRP therapies and review the literature on combination treatment for acne scars.


Assuntos
Acne Vulgar/complicações , Cicatriz/terapia , Técnicas Cosméticas/instrumentação , Plasma Rico em Plaquetas , Pele/patologia , Atrofia/diagnóstico , Atrofia/etiologia , Atrofia/terapia , Cicatriz/diagnóstico , Cicatriz/etiologia , Cicatriz/patologia , Terapia Combinada/instrumentação , Terapia Combinada/métodos , Humanos , Agulhas , Satisfação do Paciente , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Resultado do Tratamento
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