Study on the effect of combined action of topical silicone gel and pressure therapy in hypertrophic scar management

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.

O tratamento das cicatrizes de esternotomia mediana com injeções de triancinolona, placas de silicone e terapia combinada: um estudo prospectivo randomizado / Treatment of median sternotomy scars using Triamcinolone injections, Silicone Dressings and a combination group: a prospective randomized comparative study

Introdução: Placas de silicone e injeções de triancinolona melhoram o tamanho dos queloides e das cicatrizes hipertróficas, além do eritema, da elasticidade e de sintomas como dor e prurido. Esses tratamentos não são invasivos, têm um bom custo-beneficio e são amplamente utilizados como terapia inicial para queloides e cicatrizes hipertróficas; entretanto, faltam estudos comparativos dos dois tratamentos. Objetivo: Comparar o uso de placas de silicone, triancinolona intralesional, e a combinação de ambas as modalidades terapêuticas, no tratamento de cicatrizes hipertróficas na mesma área anatômica e causadas pelo mesmo mecanismo de lesão. Métodos e Materiais: Em um estudo prospectivo, 12 pacientes com cicatrizes de esternotomia mediana foram randomizados em 3 grupos (4 pacientes em cada grupo): Grupo 1. injeções mensais de triancinolona; Grupo 2. uma combinação de placas de silicone e injeções de triancinolona e Grupo 3. placas de silicone. Os pacientes foram avaliados em consultas clínicas mensais com o uso da Escala de Vancouver e durômetro. Foram realizadas imunohistoquímica e microscopia confocal para os colágenos de tipos I e VI em amostras de cicatriz. Os grupos foram comparados com os testes de Kruskall-Wallis e Friedman com significância de p< 0.05. Resultados: Os três tratamentos mostraram-se eficazes na melhora das cicatrizes, conforme demonstrado pela redução nos parâmetros da Escala de Vancouver. Foi observada uma diferença entre os três grupos no tempo 2, quando a triancinolona mostrou-se menos eficaz. O grupo 2 apresentou melhora na pigmentação (p = 0,042). Os colágenos de tipos I e VI apresentaram aumento de fluorescência em toda a derme superficial e profunda nas lesões não-tratadas, que diminuiu após do tratamento. Apesar do número pequeno de pacientes, este foi o primeiro estudo prospectivo que comparou estas modalidades de tratamento de cicatrizes, evitando vieses frequentemente vistos em publicações sobre tratamentos de cicatrizes

Introduction: Silicone dressings and Triamcinolone injections are known to improve keloids and hypertrophic scars size, erythema, flexibility, and symptoms such as pain and itching. These treatments are non-invasive, inexpensive, and widely used as first or second-line therapy; however, studies comparing them are still lacking. Objective: To compare silicone dressings, triamcinolone injections, and a combination group, to treat hypertrophic scars, at the same anatomical area, caused by the same mechanism of injury. Materials and methods: In a prospective study, 12 patients with median-sternotomy scars were randomized into 3 groups (n=4 patients each): group 1, monthly triamcinolone injections; group 2, a combination of silicone dressings and triamcinolone injections; and group 3, silicone dressings. Patients were evaluated in monthly clinical appointments using the Vancouver Scale and the durometer. Immunohistochemistry and confocal microscopy for collagen types I and VI were performed in scar samples. The groups were compared using Kruskal-Wallis and Friedman tests, with p<0,05 indicating significance. Results: The three treatments were effective in reducing the Vancouver scores. A difference between the three groups was observed at time 2 when triamcinolone was less effective. Group 2 showed an improvement on pigmentation (p = 0,042). Collagens types I and VI presented increased fluorescence throughout the superficial and deep dermis in untreated lesions, which decreased after the treatment. Although the number of patients is limited, this is the first prospective study addressing some of the major bias in scars treatment

Application of three-dimensional SPACE magnetic resonance imaging in accurate measurement of implant volume in breast surgery / 中华整形外科杂志

Objective@#The study is to assess the accuracy and reliability of three-dimensional simulated magnetic resonance imaging with silicone-excitation SPACE (sampling perfection with application optimized contrast using different flip angle evolutions) sequence for estimating implant volume.@*Methods@#(1) MRI examinations of 10 silicone implants (Wuhan Tongji Hospital from October 2018 to December 2018) were performed with T2, H2O-excitation SPACE sequence (T2-spc-H2O) and silicone-excitation SPACE sequence (T2-spc-Silicone) to find the most accurate method to estimate implant volume by ITK-SNAP. The effect of implant deformation and slice thickness of T2-spc-Silicone on volume measurement were investigated. (2) 13 normal patients and 6 patients with implant complications (Wuhan Tongji Hospital from March 2017 to May 2019) were enrolled for testing the accuracy and reliability of T2-spc-Silicone for volume measurement in vivo. The data were analyzed using Prism 8.0 software. The paired student t-test was used to compare the difference of two groups. One-way ANOVA was used to compare the difference of multiple groups. P<0.05 was considered statistically significant.@*Results@#The absolute volume differences of T2, T2-spc-H2O, T2-spc-Silicone were (42.19±2.31) ml, (23.27±1.55) ml and (6.28±1.22) ml. The absolute volume differences of T2-spc-Silicone group was significantly less than T2-spc-H2O and T2 group in vitro(F=195.3, P<0.001). No significant difference(F=1.36, P=0.22)was shown between the normality group and the deformation group for estimating the volume of implants with the slice thickness of SPACE increased from 0.5 mm×0.5 mm×0.5 mm to 5.0 mm×5.0 mm×5.0 mm. Besides, the slices thickness of SPACE from 0.5 mm×0.5 mm×0.5 mm to 5.0 mm×5.0 mm×5.0 mm did not significantly affect the accuracy of volume measurement of the implants in deformation state(F=1.22, P=0.29). The measurement error of SPACE was (8.82±0.99) ml in normal patients. Moreover, there was no significant difference between measured volume[(226.4±12.76)ml] and actual volume of implants[(225.9±11.94) ml](t=0.31, P=0.76)in patients with implant complications. The result showed excellent intraobserver reliability (ICC=0.997) and internal consistency ranged from 0.986 to 0.997 (P<0.001).@*Conclusions@#The method to measure implant volume by silicone-excitation SPACE sequence had desirable accuracy and reliability. The deformation of the implant and the slice thickness of the SPACE sequence did not exhibit a significant effect on the accuracy of volume measurement.

Comparison of the Efficacy of Intralesional Triamcinolone Acetonide and Silicone Gel Sheeting for the Treatment of Keloids

Intoduction:There are multiple treatment modalities for keloids but no single modality has been proven to be thegold standard. This study aims to compare the efficacy of intralesional triamcinolone acetonide (TAC)with silicone gel sheeting (SGS) in treating keloids and their effect on patients’ quality of life(QoL).Methods:This was a two-arm randomized-controlled trial involving 56 subjects in which intralesional TAC 20mg/mL after dilution with 2% lignocaine was administered on keloids monthly for patients in group1 while patients in group 2 applied SGS on keloids daily. Patients were treated for 12 weeks andfollowed-up for 16 weeks. Patient and Observer Scar Assessment Scale (POSAS) and DermatologyLife Quality Index (DLQI) were assessed to monitor treatment efficacy and patients’ QoL respectively.Results:There was 44.2% of improvement in the mean of total score of POSAS in group 1 as compared to11.6% in group 2 (p<0.001). Both groups showed significant improvement in vascularity, pigmentation,thickness and pliability but the improvement was more significant in group 1. Subjects in group 1demonstrated a 67.3% of DLQI score improvement as compared to 13.1% in group 2 (p<0.001). Sideeffects reported were pain during procedure in group 1 and pruritus in group 2.Conclusion:Intralesional TAC was superior than SGS in treating keloids as well as improving patients’ QoL andhence recommended as the first-line treatment. SGS can be considered as an alternative treatment forpatients who are intolerable to pain or as an adjunctive treatment.

Reacción a un tatuaje de henna negra tratado con furoato de mometasona y gel de silicona: Caso clínico / Reaction to a black henna tattoo treated with mometasone furoate and silicone gel: case report

Black henna tattoos have paraphenylenediamine (PPD), which contains a product of herbal origin, which due to its molecular characteristics is capable of inducing, in susceptible individuals, a type IV hypersensitivity reaction. It clinically manifests as a contact dermatitis that usually when it disappears, scarring and hypopigmentation are left in the injured area. Objective: To describe the case of a patient with hypersensitivity to henna tattoo and to present the most relevant phenomena associated with this condition. Case report: The case of a 6 year-old patient with a black henna tattoo on his right leg, who was diagnosed with contact dermatitis probably attributed to PPD, is presented. Mometasone furoate and topical silicone gel treatment was started with good response. Conclusion: Mometasone furoate and silicone gel are a good possible therapeutic option for treating contact dermatitis caused by PPD as the dermatosis was resolved without residual lesions.

Los tatuajes de henna negra son aquellos que contienen parafenilendiamina (PPD), que contienen un producto de origen herbal, que por sus características moleculares es capaz de inducir, en individuos susceptibles, una reacción de hipersensibilidad tipo IV. Se manifiesta clínicamente como una dermatitis de contacto, que generalmente al desaparecer, persiste de manera residual una cicatriz hipertrófica e hipopigmentación en la zona lesionada. Objetivo: Describir el caso de un paciente con hipersensibilidad al tatuaje de henna, y presentar los fenómenos más relevantes asociados a esta patología. Caso clínico: Paciente de 6 años de edad, que se realizó un tatuaje con henna negra en la pierna derecha, en quien se diagnosticó posteriormente una dermatitis de contacto atribuida probablemente a la PPD. Se comenzó tratamiento con furoato de mometasona y gel de silicona con buena respuesta por vía tópica. Conclusión: El furoato de mometasona y gel de silicona son una posible opción terapéutica de utilidad para tratar la dermatitis de contacto causada por el PPD, debido a que la dermatosis se resolvió sin lesiones residuales.

A Retrospective Analysis of Ruptured Breast Implants

BACKGROUND: Rupture is an important complication of breast implants. Before cohesive gel silicone implants, rupture rates of both saline and silicone breast implants were over 10%. Through an analysis of ruptured implants, we can determine the various factors related to ruptured implants. METHODS: We performed a retrospective review of 72 implants that were removed for implant rupture between 2005 and 2014 at a single institution. The following data were collected: type of implants (saline or silicone), duration of implantation, type of implant shell, degree of capsular contracture, associated symptoms, cause of rupture, diagnostic tools, and management. RESULTS: Forty-five Saline implants and 27 silicone implants were used. Rupture was diagnosed at a mean of 5.6 and 12 years after insertion of saline and silicone implants, respectively. There was no association between shell type and risk of rupture. Spontaneous was the most common reason for the rupture. Rupture management was implant change (39 case), microfat graft (2 case), removal only (14 case), and follow-up loss (17 case). CONCLUSIONS: Saline implants have a shorter average duration of rupture, but diagnosis is easier and safer, leading to fewer complications. Previous-generation silicone implants required frequent follow-up observation, and it is recommended that they be changed to a cohesive gel implant before hidden rupture occurs.

Rupture of the Cohesive Silicone Gel Implant after Breast Augmentation

PURPOSE: Breast augmentation with cohesive silicone gel implant has been popular but there remains the risk of implant rupture. We investigated the diagnosis and treatment of cohesive gel implant rupture. METHODS: Ten cases of cohesive gel implant rupture between August 2006 and August 2010 in ooo were reviewed in this study. The diagnostic role of Magnetic resonance imaging (MRI) and ultrasonography (US), and operative findings of cases were studied retrospectively. RESULTS: The mean interval from previous surgery was 14.7 months ranging from 3 to 44 months. Nine cases were visited due to abrupt changes in texture of implants and 1 case for revision of capsular contracture. Seven of 10 cases had capsular contracture, simultaneously. We diagnosed the first case by US and MRI but only US was used in the other 9 cases. US showed discontinuity of the implant membrane and multiple parallel echogenic lines within the implant interior (stepladder sign), and MRI showed the presence of multiple curvilinear low-signal-intensity lines seen within the high-signal-intensity silicone gel (linguine sign). All the ruptured gel remained in place within the capsule and did not migrate into the surrounding area. Surgeries were implant replacement in 3, replacement with capsulectomy in 6 with capsular contracture, and subpectoral conversion with capsulectomy and mastopexy in 1 case. CONCLUSION: US without MRI has asatisfactoryrole in the screening method for detection of cohesive silicone gel implant rupture in symptomatic cases. Ruptured implants were removed and replaced easily due to their highly cohesive nature.

Prosthodontist contribution in treating post-burn hypertrophic facial scars.

The formation of hypertrophic scars is common following healing of the burn wound, particularly in children. The face is one of the areas of the body most frequently affected by burns. Scar formation as a result of burn wounds leads to contraction of the formed granulation tissue, which causes both aesthetic and functional impairment for the patient. Scarring has major psychological and physical repercussions. Scarring on the face and visible regions of the body can be very distressing for the patient. Prevention of scars involves early and continuous use of a compressive orthesis. However, their efficacy is often limited to the facial region because of the contours of this area of body. This paper describes a clinical case of post-burn hypertrophic scars treated with silicone gel sheeting applied with pressure under custom made auto-polymerizing resin stent.

Predicting the Degree of Breast Size in Augmentation with Cohesive Gel Implant

PURPOSE: Predicting the change in breast size for a specific patient's need is a challenging problem in breast augmentation. We intended to investigate the post-augmentation degree of breast size according to the size of cohesive silicone gel implant. METHODS: To predict post-augmentation breast size, we measured 100 patients' pre-and postoperative 3 month's bust circumference. All patients were performed by total subfascial breast augmentation with moderate profile cohesive silicone gel implant through areolar omega (transareolar-perinipple) incision. RESULTS: According to this study, each additional one pair of 100mL in implant size yielded an approximate 1.5cm increase in bust circumference(p=0.006). CONCLUSION: From this result, we conclude that each additional one pair of 100mL in implant volume yielded about 1.5cm increase in bust circumference. Although this result may not be applied to every patient, we believe that it yields a practical chart that can help to predict the amount of increase in breast size with the use of cohesive silicone gel implant of a specific size preoperatively.

The comparative analysis of two approaches in breast augmentation / 国际外科学杂志

Objective To compare the curative effects of two different approaches in the surgical treatmentof small breast.Methods Fourty-seven patients with small breast were treated at our department.Twenty-eight sides of patients adopted an approach of prosthesis while the nineteen sides of patients were treated in the approach of autologous fat granules injection.Clinical assessment was done by analyzing operation time,blood loss volume,hospitalization duration and recent and long-term complications in breasts.All the pa-tients were followed up for thirty-two months on average.Results During follow-up period the appearance ofbreast was satisfied.Silicone gel breast prosthesis was well tolerated and the whole operation time was about (35±5 )min,the amount of blood loss was (35±5 ) mL,hospitalization duration was (2±1 ) days,during thefollow-up period prosthesis capsular contracture after hematoma occurred in one patient.The use of autolo-gous fat granules injection to breast augmentation was found limited,and the whole operate time was about (35±5 ) rain,the amount of blood loss was (15±5 ) mL,hospitalization duration was (1±1 ) days.With in-jection(2±l)times.During the follow-up period,one patient had infection,one patient liquefied fat,andone patient the induration.Conclusion Each treatment approach has its own advantages and disadvanta-ges.The approprite one should be selected according to the special situation of patients.

Adhesive Silicone Gel Sheet for Treatment of Nailbed Injury

If autogenous nail is lost in nail bed injuries, alternative effective nail bed protection material is questionable in postoperative follow up period. The conventional modality with autogenous nail coverage have several disadvantages such as drawback of maintenance, higher chance of loss and complex dressing step (eg. ointment apply for humidification and nail fixation using tape or bandage). So, we have studied the usefulness of adhesive silicone gel sheet for alternative nail bed protection material until the end of nail regeneration. From March 2003 to July 2004, we have experienced 215 traumatic nail bed injuries except fingertip loss. Among these patient, we classified two groups, 30 cases with autogenous nail protection(Group I) and 30 cases with adhesive silicone gel sheet protection(Group II). Mean full nail growth time was 3.6 months in group I and 3.8 months in group II. Mean final nail appearance score(0: poor, 4: excellent) was 3.0 in group I and 3.5 in group II. Adhesive silicone gel sheet protection(Group II) was slightly superior to the autogenous nail protection in final appearance, especially sterile matrix laceration. In conclusion, we believe that adhesive silicone gel sheet application is a simple, acceptable, alternative method for protecting nail bed with loss of autogenou nail. It has a number of advantages compared with autogenous nail such as better humidification, controllable hygiene, less pain, less hospitalization, less frequent visit, less chance of loss, avoiding complex dressing step and more even pressure with adhesiveness, flexibility and durability.

Conservative Treatment with Silicone Gel Sheet of Aplasia Cutis Congenita: Case Reports

Aplasia cutis congenita represents a congenital absence of all skin layers, and it may occasionally extend through the bone and dura of the skull. Since the first report by Cordon in 1767, over 500 cases have been reported. Eighty percents of all cases are found in the scalp, and 20 percents of these cases involve extremities and trunk and are often bilaterally symmetrical. Histologic examination demonstrates a layer of thin dermal collagen without overlying epithelium or adnexal structures. It has several clinical groups classified by the location and pattern of the skin defect, associated anomalies and the mode of inheritance. Its management is controversial and may be conservative treatment or the surgical option to provide definite skin cover. In 1990, Wexler suggested that conservative treatment using Silvadene was the preferred option. We would like to present 2 cases in which silicone gel sheet as a conservative treatment modality led to favorable outcomes. It was invented for the treatment of hypertrophic scar but has been used and studied for the open wounds in recent years. The use of silicone gel sheet on congenital skin defect has many advantages: the danger of infection is minimized due to frequent washing; prolonged hospitalization is prevented; pain or bleeding is minimized for dressing changes because it doesn't adhere to the wound; and it can be used after the epithelization for the prevention of hypertrophic scar.

Efficacy of Tie-over Dressing Using Silicone Gel Sheet in Skin Graft on Flat Surface

Success of skin grafts depends on sufficient immobilization and early intervention for hematoma, seroma, or infection. To stabilize and cover skin grafts with a tie-over technique was used with translucent silicone gel sheet on flat surface. Skin defect was resurfaced with skin grafts. A sterile silicone gel sheet was placed over the skin graft. Gel was fixed to the wound edges with skin sutures. Skin graft healed without any complications. Using silicone gel sheet in skin graft on flat surface is an effective method for stabilization, which also allows direct visualization of the graft designed to inspect hematoma-like complications.

A Study for skin hypersensitivity of silicone Gel sheet by skin patch test

Silicone gel sheeting is widely used to manage the hypertrophic or keloid scars. Since first reported in 1982 to be an effective treatment for burn scars and contractures, many authors reported its efficacy to treat scars. Chemically silicone gel sheet composed of cross-linked dimethy1 and vinyl enblocked polydimethylsiloxane polymer. The exact mechanism of silicone gel sheet to treat hypertrophic scar was still unknown, but decreasing the water vapor transmission was supposed to level the scar. During out clinical experience, a few patients suffered from skin problems by silicone gel sheeting. So we designed a study to determine the severity of skin hypersensitivity of silicone gel sheeting. Four types of silicone gel sheets were applied to upper arms of 140 healthy voluntees. Resultant skin lesions were analysed 48 and 96 hours later to differentiate the irritation and the true hypersensitivity. About 30 percent of voluteers represented mild skin irritability(48 hours later), but true skin hypersensitivity was not found(96 hours later). The site to be applied with silicone gel sheet is very critical area, so pretesting the irritability of silicone gel sheeting to individuals is an important step to control the hypertrophic scar.