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ABSTRACT BACKGROUND: Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life. OBJECTIVES: To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS. DESIGN AND SETTING: Retrospective cross-sectional single-center study on data covering January 2009 to December 2019. METHODS: Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS. RESULTS: Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence. CONCLUSIONS: VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.
Subject(s)
Humans , Male , Urethral Stricture/surgery , Urethral Stricture/etiology , Urethral Stricture/prevention & control , Cicatrix, Hypertrophic , Postoperative Complications/prevention & control , Prostatectomy/adverse effects , Quality of Life , Urethra/surgery , Cross-Sectional Studies , Retrospective Studies , Constriction, Pathologic , Neoplasm Recurrence, Local/prevention & controlABSTRACT
Objective:To determine the clinical effect of sequential therapy by local injection of triamcinolone acetonide and lattice CO 2laser for hypertrophic scar. Methods:A total of 80 hypertrophic scar patients, including 45 male and 35 female, in our clinic were randomly divided into test ( n=40) and control ( n=40) groups from March 2019 to May 2020. Patients aged from 18-42 years with average age 28.1. Patients in test groups were treated with triamcinolone acetonide and lattice CO 2laser sequentially. After final treatments, third-party blind evaluation, Vancouver scar scale, visual analog scale and dermatology life quality index were performed. Results:Test group acquired more satisfied result in third-party blind evaluation (82.5% vs. 52.5%, χ2=8.216, P<0.05). Vancouver scar scale, visual analog scale and dermatology life quality index were not significantly different before treatment for both groups while test group acquired better improvement after treatment ( P<0.05). Conclusions:Sequential therapy by local injection of triamcinolone acetonide and lattice CO 2laser is effective for hypertrophic scar and worths wide application in the clinic.
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Background: Widespread hypertrophic scars usually resulting from burn injuries or extensive soft tissue trauma is a common problem presented to plastic OPD. Non-invasive treatment like Pressure/compression therapy and siliconee sheets and gels are well-accepted, evidence-based recommendations for a long time. Very few studies are there for their combined effect on hypertrophic widespread scars. Aims and objectives of the study was to see the outcome of hypertrophic scar management following application of combined therapy of silicone gel and pressure garment.Methods: In the present study we have taken patients, who were randomly allotted in two groups. In one group only silicone gel was used for scar management while other group we applied silicone gel along with customized pressure garment locally for 6 months. Patients are seen in OPD monthly and after 6 months final results were analyzed, to see the effect of combined therapy.Results: Although silicone gel is alone is effective in widespread post burn scar, pressure garment provides a synergistic effects when used together. There is no significant change in colour and vascularity, but changes in scar thickness and pliability are most significant in combined therapy group.Conclusions: For small linear scar silicone gel treatment is alone sufficient, but for widespread hypertrophic scar this should always be used along with pressure garment therapy.
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BACKGROUND: Facial scars are mainly caused by trauma or surgery, which greatly affect the appearance. Dermatologists and plastic surgeons have tried many ways to change the appearance of scars. Botulinum toxin A injection is widely used in clinical practice for prevention of scars, but the efficacy and safety are not proved. OBJECTIVE: To evaluate the effectiveness and safety of botulinum toxin A injection in the prevention of facial trauma or postoperative hypertrophic scar. METHODS: PubMed, EMbase, the Cochrane library, CNKI, CBM, WanFang, and VIP were searched for randomized controlled trials regarding botulinum toxin A injection in the prevention of facial scars. Manual retrieval was done for supplement of incomplete data. Two doctors were responsible for literature screen and evaluation. Finally, 11 randomized controlled clinical trials were included. The experimental group was injected with botulinum toxin A, and the control group was given saline or nothing. Part of the data was analyzed using Revman 5.3 software for meta-analysis, and the data that could not be analyzed using software were subjected to a descriptive analysis. RESULTS AND CONCLUSION: Eleven randomized controlled trials were included, involving 436 patients with 518 wounds. Meta-analyses showed that Vancouver scar scale score, visual analogue scale score and width of scars in the botulinum toxin A group were significantly better than those in the control group (weighted mean difference (WMD)=-1.61, 95% confidence interval (CI)=-2.06 to -0.26, P = 0.02; WMD=1.7, 95%CI=0.38 to 3.02, P = 0.01; WMD=-0.17, 95%CI=-0.22 to -0.12, P < 0.000 1). Incidence of adverse reactions of botulinum toxin A group was higher than that in the control group (χ2 =8.335, P=0.004), but they were all slight and easy to release. There were no serious adverse events in both groups. It seems that botulinum toxin A injection can reduce the width of scars, improve Vancouver scale and visual analogue scale scores. However, it is suggested to make clear communication before and after the operation and take measures to deal with various adverse reactions in advance.
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Objective@#To compare the scar condition after breast implantation with axillary, periareolar and inframammary fold (IMF) incisions.@*Methods@#The consecutive patients who were diagnosed as breast hypoplasia and underwent breast implantation surgeries between May 2012 to December 2014 were included in the research. The scars were assessed at 1, 6 and 12 months after surgery with VSS and patient satisfaction scoring. The results were analyzed with Variance and Kruskal-Wallis test based on the data type.@*Results@#The scars of 173 patients were assessed 3 times with the follow-up rate being 82.4%. The VSS scores of every incision declined with time, and the patient satisfaction scores increased gradually. At one month after surgery, the media VSS scores were 6 in axillary group and 4 in periareolar and IMF groups, the differences had statistical significance (P<0.05). The media scores of patients satisfaction were 8 in periareolar group and 7 in axillary and IMF groups. The scores of periareola group were higher than those of axillary with statistical significance(P<0.05). When 6 months after surgery, the media VSS scores were 4 in axillary group and 3 in periareolar and IMF groups. The scores of axillary group were higher than those of IMF with statistical significance(P<0.05). The media scores of patients satisfaction were 8 in 3 groups. When 12 months after surgery, the media VSS scores were 0.5 and 1 in periareolar group (left and right respectively), and 2 in axillary and IMF groups. The media scores of patients satisfaction were 9 in 3 groups. No differences were found in VSS and patients satisfaction scores among three kinds of incisions (P>0.05).@*Conclusions@#The scars of three incisions achieved similar cosmetic effects and patient satisfaction at long-time follow-up.
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Objective To study the clinical effects of sailboat resection of nasal alar flap combined with catgut embedding in the treatment of severe hypertrophy of the nasal alar.Methods Patients with severe alar hypertrophy were photographed before operation,and the length of alar,the height of nasal ala,the length of nostrils and the width of nostrils were measured.After one month and half a year follow-up,the length of alar,nasal alar height,nostril length,nostril width and nasal width were measured,and the local scar condition was scored according to Vancouver scar scale (VSS).Results Through the combination of two kinds of surgical treatment of severe nasoalar hypertrophy,the surgical effect of satisfaction showed that,with the comparison before and after surgery,nose length and height,length and width of the nostril and the nasal base width were significantly reduced (P＜0.05) after half a year and one month after operation.The data showed no significant changes (P＞0.05),and so the postoperative effect could be sustained;local scar scale,after half a year and one month after operation,were significantly decreased (P＜0.05),and the postoperative long-term scar was not obvious.Conclusions The effect of alar sailboat-resection combined with catgut embedding therapy is satisfactory for the treatment of severe alar hypertrophy.It is one of the ways to treat severe alar hypertrophy.
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Objective:To assess the therapeutic effect of mucopolysaccharide polysulfate cream in prevention of postoperative scars.Methods:One hundred postoperative patients were divided into an experimental group and a control group (each n=50).After stitch removal,the experimental group wiped mucopolysaccharide polysulfate cream,and the control group wiped urea cream.The scars of the two groups were evaluated by Vancouver Scar Scale (VSS) on the day of stitch removal and in the 4th,8th,12th,16th,20th,24th,28th,and 32th weeks during the treat process.Results:At the beginning of treatment,the total VSS scores in the experimental group were always lower than that in the control group (P＜0.05).There was no difference between the two groups in the color scores at each time point of follow-up (P＞0.05).Form the 20th week,the vascular distribution scores in the experimental group were lower than that in the control group (P＜0.05).And the thickness and flexibility scores in the experimental group were lower at each time point of follow-up (P＜0.05).There were no differences between the two groups in wounds in head,face,or neck in the total VSS scores and all index scores (P＞0.05),and the total VSS scores in the experimental group,who had wounds in chest,shoulder,or back,or had wounds in waist,abdomen,or hip,or had wounds in extremity,were lower than that in the control group (P＜0.05).The vascular distribution and thickness scores in the experimental group,who had wounds in chest,shoulder,or back,were better than that in the control group (P＜0.05).Conclusion:Wiping mucopolysaccharide polysulfate cream after operation as soon as possible can effectively prevent scar hyperplasia,and it is worth to be widely applied in clinic.
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Objective@#To explore clinical application effects of skin distractor on the treatment of scars and to observe effects of skin distractor with different pull speeds on different parts scars of human body.@*Methods@#One hundred and four patients with scars, conforming to the study criteria, were hospitalized in our unit from January 2014 to June 2015. Patients were divided into 2 mm/d group and 4 mm/d group according to the random number table, with 52 patients in each group. After admission, skin distractors were pasted on scars in face and neck, trunk, and extremities of patients in 2 groups, with inner edges of pasteboards close to outside edges of longer sides of scars. Skin distractors in 2 mm/d group and 4 mm/d group were pulled to scars axis direction as speeds of 2 mm/d and 4 mm/d, respectively. Pull time equals values of pull speeds divided by width of scars. Scars were resected after finishing pulling. Immediately after scars resection, skin distractors were pasted again with inner edges of pasteboards close to outside edges of longer sides of incision and removed when stitches were taken out. Scars of patients were scored by Vancouver Scar Scale (VSS), and Patient and Observer Scar Assessment Scale (POSAS) was used to record scores of patient scar assessment scale (PSAS), observer scar assessment scale (OSAS) and overall scores of patients and observers of scars of patients before and one year after scars resection. Data were processed with χ2 test, independent samples t test, paired samples t test, independent samples non-parametric rank-sum test and paired samples non-parametric rank-sum test.@*Results@#(1) Scores of all scars of patients in 2 groups before scars resection were close (with t values from -1.384 to 0.622, P values above 0.05), obviously higher than those of one year post scars resection (with t values from 11.085 to 24.835, P values below 0.01). Scores of scars in face and neck, trunk and extremities in 2 groups before scars resection were close (with Z values from -1.651 to -0.035, t values from -1.549 to 0.219, P values above 0.05), significantly higher than those of one year post scar resection (with Z values from -2.992 to -2.555, t values from 8.739 to 19.076, P values below 0.01). (2) Scores of all scars of patients in 2 mm/d group of one year post scars resection were lower than those in 4 mm/d group (with t values from -2.583 to -2.018, P values below 0.05). PSAS scores of scars in face and neck and trunk in 2 mm/d group of one year post scars resection were lower than those in 4 mm/d group (with Z values respectively -2.385 and -2.198, P values below 0.05), other scores of scars in face and neck and trunk of patients in 2 groups of one year post scars resection were close (with Z values from -1.841 to -0.363, P values above 0.05). VSS scores, PSAS scores, OSAS scores, patients′ overall scores, and observers′ overall scores in 2 mm/d groups were (4.6±0.8), (28±4), (28±4), (4.7±0.7), (4.8±1.4) points, respectively, lower than those in 4 mm/d group[(5.2±0.8), (32±4), (31±6), (5.5±1.2), (5.5±1.0) points, respectively, with t values from -3.712 to -2.105, P<0.05 or P<0.01].@*Conclusions@#Skin distractor has better effects on the treatment of scars, and treatment effects of skin distractor in extremities pulled by 2 mm/d are better than those pulled by 4 mm/d.
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BACKGROUND: Hypertrophic scars result from excessive collagen deposition and increased transforming growth factor beta-1 (TGF-beta1) levels. We hypothesized that the expression of TGF-beta1 mRNA and protein would increase with the clinical severity of hypertrophic scars. METHODS: Primary dermal fibroblasts were isolated from cultures of normal skin and hypertrophic scars. The hypertrophic scars were classified by grade based on the Vancouver Scar Scale. After 96 hours of serum starvation, TGF-beta1 levels in the supernatant were determined using solid-phase, enzyme-linked immunosorbent assay (ELISA). Quantitative reverse transcription-polymerase chain reaction was performed to quantify TGF-beta1 mRNA expression. RESULTS: TGF-beta1 protein levels of hypertrophic scars tended to increase with increasing severity of the scars, according to the Vancouver Scar Scale. The differences between the normal dermal tissue (NS), hypertrophic scar grade (HS) 1, and HS4 groups were statistically significant (P<0.01). The TGF-beta1 mRNA levels of hypertrophic scars also tended to increase according to scar severity. The differences between the NS, HS1, HS2, HS3, and HS4 groups were statistically significant (P<0.01). CONCLUSIONS: The classification of hypertrophic scars according to the Vancouver Scar Scale usually matches the severity of the microenvironment of the hypertrophic scar.
Subject(s)
Cicatrix , Cicatrix, Hypertrophic , Classification , Collagen , Enzyme-Linked Immunosorbent Assay , Fibroblasts , RNA, Messenger , Skin , Starvation , Transforming Growth Factor beta1 , Transforming Growth FactorsABSTRACT
BACKGROUND: Recently, increasing attention in the field of dermatological surgery has been paid to treating skin cancers, including both premalignant and malignant lesions. The rhombic flap, one of the transposition flaps, is an outstanding method for reconstructing small- to medium-sized defects after skin surgery. OBJECTIVE: The aim of this study was to evaluate our clinical results with the rhombic flap for reconstruction after Mohs micrographic surgery (MMS), including the cosmetic aspects, complete surgical excision, and recurrence. METHODS: Between June 2010 and September 2013, 37 patients who were diagnosed with premalignant and malignant lesions on the face and extremities were treated with rhombic flaps for the reconstruction of primary cutaneous defects following lesion excisions. We reviewed the medical records and evaluated the clinical aspects and surgical treatment outcomes, and the cosmetic results were scored as excellent, good, fair, or poor. In addition, we assessed the surgical treatment outcomes using the Vancouver Scar Scale (VSS). RESULTS: Thirty-seven patients received 37 rhombic flaps. The cosmetic results of the reconstructions were gratifying, and 28 of 37 patients (75.7%) showed good to excellent results. Specifically, the cosmetic results of the modified rhombic flaps were great, and 27 of 30 patients (90.0%) showed good to excellent results. The cosmetic results on the VSS showed a high mean score (2.9). CONCLUSION: Our study showed that the rhombic flap is a simple reconstruction method and provides aesthetically pleasing results. Therefore, it could be a useful option for reconstructing defects of the face and extremities.
Subject(s)
Humans , Cicatrix , Dermatologic Surgical Procedures , Extremities , Medical Records , Mohs Surgery , Recurrence , Skin NeoplasmsABSTRACT
PURPOSE: The postoperative scar of open thyroidectomy is one of the clinical issues in patients diagnosed with thyroid disease. The aim of this study was to analyze postoperative scars in patients who underwent thyroidectomy based on the Modified Vancouver Scar Scale and to find factors for use in predicting formation of hypertrophied scars and keloids. METHODS: Clinical data from 283 patients who underwent thyroidectomy were collected randomly and analyzed retrospectively. All postoperative scars were classified according to five categories; excellent, good, moderate, hypertrophied, and keloid, using the Modified Vancouver Scar Scale according to the assessment of pliability, height of the scar, vascularity, and pigmentation. For analysis, hypertrophied and keloid were classified as bad status and others were classified as good status. RESULTS: According to our results, 84.8% of scars were classified as good status and 15.2% of scars were classified as bad status. Forty percent of patients who were in their twenties, 17.8% of patients who were in their thirties, and 22.1% of patients who were in their forties showed bad status; 92.9% of patients who were in their fifties and 89.2% of patients who were in their sixties showed good status (P=0.003). The only statistically significant factor influencing the scar status was the weight of the thyroid (P=0.022). CONCLUSION: Postoperative scars from thyroid surgery were evaluated using the Modified Vancouver Scar Scale. Age was the most important factor in formation of hypertrophied and keloid scar and the weight of the excised thyroid also influenced the scar status. Preoperative prediction of the status of the scar might be possible considering the age and size of the thyroid gland.