Effect of Compression Garment Combined with Orthosis on Facial Burn Scar / 中国康复理论与实践

Objective:To compare the effects of compression garment combined with orthosis for central face on facial burn scar to compression garment and 3D compression mask. Methods:From September, 2016 to June, 2019, 38 facial burn scar patients received compression therapy in Department of Burns and Cutaneous Surgery, the First Affiliated Hospital of Air Force Medical University. According to their preference, they wore compression garment only (CG group, n = 15), compression garment and orthosis for central face (CO group, n = 17) and 3D compression mask (3D group, n = 6) for a year. The facial scar was assessed with Vancouver Scar Scale (VSS) before and after treatment, and the comfort and medical cost was investigated with questionnaire. Results:The VSS score decreased after treatment in all the groups (F = 18.49, P < 0.05), while the VSS score was higher in CG group than in CO group (1.717 points, 95%CI 0.925 to 2.482, P < 0.001) and 3D group (1.782 points, 95%CI 0.738 to 2.827, P < 0.001), the difference was less between CO group and 3D group (0.065 points, 95%CI -0.957 to 1.088, P = 1.000). The comfort rate was 60%, 52.9% and 66.7% for CG group, CO group and 3D group, respectively, with no significant difference (P > 0.05). The medical cost was the most for 3D group (12 000 to 16 000 Yuan), and similar for CG group (3000 to 4800 Yuan) and CO group (3300 to 5300 Yuan). Conclusion:Compression garment combined with orthosis for central face is more effective on facial burn scar, similar to 3D compression mask, but cheaper than 3D mask, which can be a choice for facial scar patients in developing areas.

Repeated expanded bilateral deltopectoral flap for resurfacing severe facial-cervical scar / 中华医学美学美容杂志

Objective To investigate the application of the repeated expanded bilateral deltopectoral flap for resurfacing severe facial cervical scar, with review of relating articles to discuss issue of repeated expanding flap.Methods Nine patients suffered from hyperplastic facial and cervical scar.Two soft tissue expanders were implanted into the anterior chest region at both sides of sternum.The center of inner border of the expander was at the cross of second intercostal and parasternal line, and the lengthways axe of the expander was located at the ligature of the second intercostals and mammary areola.After two weeks when the expander was filled, expanded flap was transferred to cervical defect.The transferred flap was repeated expanded after half a year and transferred to resurface facial defect.Results In the first expansion stage, 600 or 800 ml expander were implanted in each side of sternum.In the second stage, 400 or 500 ml were used.The first stage of expanding process was smooth, and 2 of the expanding flaps were ruptured during the second expansion period.400-520 cm2 (average 440 cm2) additional expanded flap was acquired during two stages of expanding.Conclusions The repeated expanded bilateral deltopectoral flap gives us greater opportunity to repair severe facial-cervical scar.The best interval time of the two-stage expansion is over half a year.The speed of second expansion should be lower than that in the first stage, and protecting the expanding flap carefully from external force compression is needed during the second expasion.

Clinical efficacy of free expanded deltopectoral perforator flaps for aesthetic repair of large facial scars / 中华医学美学美容杂志

Objective To investigate the effect of expanded deltopectoral perforator flap as a free skin flap for distant transfer to aesthetically repair large facial scars via microsurgical technique.Methods 20 cases of large facial scars were treated with free expanded deltopectoral skin flaps via microsurgical technique.At the first stage,24 large volume expanders were inserted into the subcutaneous pockets in the deltopectoral zone.4 to 6 months later,the second stage operation was performed when the flaps were expanded fully and facial scars removed;deltopectoral perforator flaps harvested choosing the second or the third thoracic artery perforating branches as the pedicle;the surface of the wound was covered with the flaps.Results All of the 24 flaps survived completely and the wounds healed well after transplantation.The 6 months to 2 years' follow-up results showed that the color and texture of the flaps matched the recipient place well without swelling.The superficial and deep sensation recovered very fast.Conclusions It is safe,practical and effective that the delto-pectoral perforator flaps are used to repair large facial scars avoiding the shortcomings of traditional pedicle transfer such as more procedures,longer fixed time,or more wasted expanded skin.Free transfer of expanded delto-pectoral perforator flaps can achieve ideal function and aesthetic effects.

Excessive expansion of cervical skin to repair lower hemifascial scar / 中华医学美学美容杂志

Objective To explore the reconstruction effects of lower hemifascial scar by cervical skin excessive volume expansion. Methods Single 100 ml or 150 ml standard volume tissue expander was implanted under the cervical skin in 50 patients with lower hemifascial scar. After the tissue expanders were injected with 4-5 times than the designed volume, the scar was resurfaced with the expanded flap. Results The excessively expanded cervical flaps of 50 patients all were successfully used to reconstruct the facial scar. The expanded flap was matched well with surrounding skin after 3-12 months following-up. No obvious contracture was observed. The district recontrueted by expended flaps have the normal expression aetivities. Conclusion Excessive expansion of cervical skin can promote the efficiency in the reconstruction of the lower hemifascial scar.

More Effective Facial Scar Revision in Asian

Facial scar is very stressful for patients and physicians, especially in the case of non-parallel to relaxed skin tension line (RSTL). In general, for long facial scar not parallel to RSTL, Z-plasty or W-plasty has been performed to change the direction of scar or divide it into multiple segmented scar. These methods would be suboptimal, however, in the instance of Asian skin prone to scar formation. So, we experienced good results for scar revision through scar excision and solid subcutaneous- dermal repair to minimize scar widening despite of leaving linear type of scar. From July 2004 to March 2007, our methods were undergone for facial scar longer than 3cm in 84 patients. All scars were excised along the scar margin and subcutaneous tissue and dermis were repaired using single layer of subcutaneous-dermal stitch with 4-0 or 5-0 PDS to elevate wound margin 3-4mm higher than adjacent skin surface. Skin was repaired with 6-0 Prolene. The rate of satisfaction was over 89%(75 of 84 patients), the mean scar widening was 0.61+/-0.20 mm, and secondary operations were made in 3 patients. The Asian skin has some characteristics such as thick skin, increased melanin, energetic proliferation of fibroblast, and vigorous collagen formation, etc. Because of characteristics of Asian skin mentioned above, the linear pattern repair, technically easier than Z-plasty or W-plasty, would be superior to them in terms of the results. The essentially important point for scar revision in linear pattern is very strong subcutaneous-dermal repair to make elevation of wound margin enough for tolerating the skin tension and preventing scar widening.

Treatment of Facial Scars with CO3 Laser

Numerous modalities have been used to treat facial scars. Although excellent results can be obtained by high-energy, pulsed carbon dioxide(CO2) laser, significant morbidity exists due to the considerable thermal damage to the skin. CO3 Laser combines the performance of a CO2 system with the safety and convenience of an Er:YAG laser. The CO3 effect is due to a wide range of pulse durations, up to 20 times longer than those delivered by conventional Er:YAG lasers. The result is a thermally tunable laser, with a zone of thermal effect up to 100micrometer in depth. With the CO3 laser, the user chooses the correct depth of thermal effect for maximum safety and efficacy. This study was performed to evaluate the effect of the long-pulsed Er:YAG CO3 laserbrasion in treatment of scars and propose that it can be a effective method to improve cosmetic results. The authors treated 47 cases (8 males and 39 females) including acne scar(n=8), annular atrophic scar(n=9), posttraumatic scar(n=19), postsurgical scar (n=11) with CO3 laser. Questionaire were completed for clinical assessment by the patients and clinicians. Excellent and good results were achieved in 87.3% of scars in clinician's assessments and in 78.8% of scars in patient's assessments. In conclusion, resurfacing with a long-pulsed Er:YAG laser is a safe and very effective treatment modality for facial scars.