Aesthetic Treatment of Acute Burns of the Face Using Electro-Photobiomodulation.

The quicker a second-degree burn wound heals, the less surgery is required. Low-energy laser therapy may expedite the healing of wounds, according to recent literature findings. To establish this, it was decided to carry out a clinical trial on acute burn patients to demonstrate whether electro-photobiomodulation (EPBM) therapy can hasten wound closure, thereby obviating the need for surgery without worsening hypertrophic scarring and contracture. In clinical prospective analysis, 42 acute burn patients with recent burns to the face alone (13) or the face and additional areas (29). Twenty-six males and 16 women were included. All patients received twice-weekly sessions of intense pulsed light (IPL) and radiofrequency for the face and other areas. Clinical assessment showed excellent results in 34 (81%) patients, good results in 6 (14.3%) patients, fair results in two (4.7%) patients, and no poor results were reported. The results of this clinical trial showed that IPL and radiofrequency therapy can rapidly heal deep skin burns without the need for surgery. and lowered the incidence of hypertrophic scarring and contractures. EPBM induces better aesthetic and functional outcomes (particularly in burns of the face).

Hypertrophic Scars of the Hand: The Role of Electrophotobiomodulation Theory as a Recent Line of Treatment.

BACKGROUND: A more enduring strategy for the treatment of hypertrophic scars of the hand is still a challenge facing restorative dermatologists and plastic surgeons. Nonetheless, with the use of nonablative devices, intense pulsed light and different types of lasers have started to yield promising outcomes and are close to becoming an effective and dependable technique. The advances in radiofrequency energy have brought new life to optical-based frameworks. Radiofrequency current delivers an unadulterated heat effect according to the electrical response characteristics of each tissue. The purpose of this study was to assess the patient satisfaction, safety, and clinical efficacy of the use of electrophotobiomodulation (combined intense pulsed light and radiofrequency energy) in the treatment of postburn hypertrophic scars of the hand. METHODS: This was a prospective clinical study that was performed on 56 patients who presented with postburn hypertrophic scars on the hands between March of 2013 and January of 2020. RESULTS: The clinical appraisal showed excellent results in 33 patients (58.9%), good results in 18 patients (32.2%), fair results in five patients (8.9%), and no poor results. CONCLUSION: The use of radiofrequency energy combined with intense pulsed light was effective for the treatment of hand scars on people with various skin tones. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Prominent Ear Correction Using Full-Thickness Cartilage Strip: An Incomplete Cutting Technique.

BACKGROUND: Prominent ears are one of the most well-known facial disfigurements influencing youngsters. Approximately 5% of the population suffers from some degree of ear prominence. More than 200 techniques have been used for the surgical correction of prominent ears, referring that no single "best" method exists and that techniques and modifications will continue to appear. OBJECTIVES: In this work, we are going to evaluate the results of using a full-thickness cartilage strip, an incomplete cutting technique for the correction of various degrees of the prominent ear. PATIENTS AND METHODS: This prospective controlled clinical trial was carried out on a sum of 63 patients, who presented with prominent ear deformity, in the period between March 2014 and January 2020 at the plastic and reconstructive surgery department, Tanta University Hospitals, and private clinic. RESULTS: Sixty-three patients were operated upon, 46 were males and 17 were females, their age ranged between 4 and 23 years, and their mean age was 9.7 years. Clinical results showed excellent results in 37 patients (58.7%), good results in 18 patients (28. 6%), fair results in 8 patients (12.7%), and no poor results. Patient satisfaction showed excellent results in 32 patients (50.8%), good results in 22 patients (34.9%), fair results in 9 patients (14.3%), and no poor results. CONCLUSIONS: Prominent ear correction using full-thickness cartilage strip, an incomplete cutting technique, is a good technique. It can be used in the correction of different varieties of prominent ears. It has a very low incidence of complications. No hypertrophic or keloidal scars have been reported.

Epiderm-Abrasion-Assisted Intensive Pulsed Light and Radiofrequency in Aesthetic Treatment Extensive Facial Freckles.

BACKGROUND: Freckles are typical epidermal pigmented disorders that occur at sun-exposed areas, presenting with dark-brown or light-brown circular hyperpigmentation. A lot of treatment modalities have been used for treatment of freckles like chemicals, electrosurgery and cryotherapy. These treatments may cause undesirable side effects such as scaring (Sarkar et al. in Indian J Dermatol 62(6):578-584, 2017). Microdermabrasion has been used in treatment of freckles; however, the results are not satisfactory, as it removes the outermost layer of the epidermis only (El-Domyati et al. in J Cosmet Dermatol 15(4):503-513, 2016). Also ablative lasers and non-ablative lasers have been used but have not proved to be completely satisfactory and share a common risk of post-inflammatory hyperpigmentation (Jang et al. in Dermatol Surg 26:231-234, 2000). In our study, we have used epiderm-abrasion-assisted intensive pulsed light (IPL) and radiofrequency (RF) to study their effect in treatment of freckles. PATIENTS AND METHODS: this prospective controlled clinical trial was carried out on 48 patients, who presented with extensive facial freckles, in the period between March 2015 and April 2018. The epiderm-abrasion procedure was performed first, and then, electro-photobiomodulation sessions were started two weeks later. RESULTS: This study was carried out on 48 patients, 39 female and 9 males. Their age ranged between 12 and 58 years old. According to Fitzpatrick classification, four patients were type II, 30 patients were type III, and 14 patients were type IV. The results were excellent in 32 cases, good in 12 cases, fair in four cases, and we have no poor results. Side effects like hyperpigmentation were reported in three patients (6.3%), one case grade III and two cases grade IV Fitzpatrick skin type. No cases with hypopigmentation, or scars, were reported. CONCLUSIONS: Epiderm-abrasion and electro-photobiomodulation (IPL&RF) are effective methods in treatment of facial freckles. Some complications may occur post-procedure such as hyperpigmentation, hypopigmentation and abnormal scarring. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Carbon Dioxide Cryotherapy for Treatment of Nasal and Perinasal Congenital Melanocytic Nevi.

Congenital melanocytic nevi, reported in 1% to 6% of newborns. There are many complications the most dangerous is the malignant transformation, but the most depressive is the cosmetic one specially for facial lesions. There is a wide range of treatment modalities none of them provide an acceptable solution for facial lesions. In this study we provide a simple, cheap and effective treatment modality for nasal and perinasal congenital melanocytic nevi. In our study, significant improvement was observed with no repigmentation throughout the follow-up period. We conclude that carbon dioxide cryotherapy is an effective treatment modality for nasal and perinasal congenital melanocytic nevi that should be used by others to stand on its long-term persistence and possible complications.

Comparison of Nd: YAG Laser and Combined Intense Pulsed Light and Radiofrequency in the Treatment of Hypertrophic Scars: A Prospective Clinico-Histopathological Study.

INTRODUCTION: Hypertrophic scars are fibroproliferative disorders, seen after burn, trauma, and/or surgery. We aimed to compare the clinical and histopathological results of 1064-nm Nd:YAG laser and combined intense pulsed light and radiofrequency in the treatment of hypertrophic scars. METHODS: Fifty patients with hypertrophic scars were included in this prospective, randomized study. Twenty-five patients were treated with Nd:YAG laser and 25 patients with combined intense pulsed light and radiofrequency (E-light). The scars were evaluated at baseline, during and at 3 months after the final treatment session using the Vancouver scar scale. Biopsy specimens from scars were obtained before, during, and 3 months after the final treatment session and were stained with hematoxylin and eosin stain, Masson's trichrome stain, and immunostaining procedures for collagen I, collagen III, and TGF-ß1. RESULTS: Significant improvements in the total Vancouver scar scale scores before and after the treatment in both groups (P < 0.001); however, a significant difference between both groups (P < 0.001), regarding the E-light, which showed better response than Nd:YAG laser. Hematoxylin and eosin and Masson's trichrome staining showed arrangement and thinning of collagen bundles and reduction in collagen density by in both groups, but the collagen bundles thinning and parallelism were more obvious in the E-light group. Significant decrease in the concentration of collagen I, collagen III, and TGF-ß1 in the E-light group as compared with the laser group (P = 0.005, P = 0.003 and P < 0.001, respectively). CONCLUSIONS: Both modalities were successful in the treatment of hypertrophic scars; however, a significant improvement in the clinical and histopathological findings was detected with the E-light method.

Nipple-Areola Complex Ischemia or Necrosis in Freestyle Perforator Flap Reduction Mammoplasty Operations.

BACKGROUND: Necrosis of the nipple-areolar complex (NAC) is one of the most devastating complications of reduction mammoplasty. A variable, asymmetrical pattern of blood supply from the main sources was found in the same individual. To solve this problem, we present a method to be sure that the blood supply to the NAC is contained within the designed pedicle during reduction mammoplasty. This is done using the colored duplex scan and handheld Doppler to perform freestyle perforator flap reduction mammoplasty. METHODS: This is a prospective randomized study that has been performed on 105 patients in the period between January 2014 and 2019 at the Plastic and Reconstructive Surgery Department, Tanta University Hospitals. Freestyle perforator flaps were performed for all cases after perforator detection using handheld Doppler and confirmed by colored duplex scan. RESULTS: The procedure was performed as freestyle on medial perforators in 35 (33.3%) cases, on lateral perforators in 20 (19%) cases, on combined medial and lateral perforators, as a bipedicle in 30 (28.7%) cases, on upper pole perforators in 12 (11.4%) cases, and on lower pole perforators in 8 (7.6%) cases. CONCLUSIONS: The use of handheld Doppler and the confirmation by duplex scan are mandatory to decrease the incidence of NAC necrosis or ischemia. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.

Free Style Perforator Flaps for Aesthetic Facial Reconstruction.

BACKGROUND: Functional and cosmetic outcomes affect reconstruction of the face more than any region of the body. To use a predetermined perforator flap freely designed allowing a wide range of movement and manipulation can give us an optimum outcome. We present our clinical experience with free style facial perforator flaps, surgical technique, and complications. METHODS: Thirty patients with post-tumor resection of the face were reconstructed with free style local perforator flaps between January 2014 and November 2016. Doppler was used to identify the perforator vessels preoperatively. RESULTS: Twenty-two clinical cases had no complications. Four had venous congestion that resolved spontaneously, three had a distal 1/3 superficial necrosis, and one suffered from hematoma. CONCLUSION: Freestyle perforator flaps were applied to get better cosmetic facial reconstruction, allowing one stage procedure and decreasing donor site morbidity. Modern anatomical understanding, good planning, and meticulous surgical technique can affect clinical results.

Treatment of Gigantomastia Using a Medial-Lateral Bipedicle Reduction Mammoplasty: The Role of Doppler-Assisted Preoperative Perforator Identification.

The purpose of this study is to introduce a breast reduction technique designed to reduce the incidence of postoperative nipple-areola complex ischemia and necrosis following reduction mammoplasty, while at the same time allowing all the other goals of breast reduction to be realized. This is achieved through preoperative detection of perforating vessels supplying the nipple-areola complex using a hand-held Doppler. The horizontally based parenchymal pedicle is designed to include these perforators whether originating from the internal mammary artery, lateral thoracic artery or both. This technique provides freedom in pedicle shaping and fixation to the pectoral fascia to achieve the best breast contour. The study included 50 patients equally divided into two groups: the study group (using preoperative Doppler for detection of perforators) and control group (without preoperative Doppler). The average body mass index of our patients was 32.4 and 29.8 for study and control groups, respectively. The average suprasternal notch to nipple distance was 40.8 cm in the study group and 38.9 cm in the control group. In all cases of the study group, both medial and lateral pedicles were used each of them containing one perforator. The average resection weight per side was 1433.6 g for the study group and 1173.2 g for the control group. None of the study group cases experienced NAC necrosis, while four cases of the control group experienced NAC necrosis (3 partial and 1 total). The horizontally based parenchymal pedicle constructed with the aid of preoperative perforator identification with a Doppler is an effective technique for breast reduction that results in a very low rate of postoperative ischemia and necrosis of the nipple-areola complex. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Electrophoto-Biomodulation in Aesthetic Treatment of Postburn Hypopigmentation: Clinical Response in Relation to Histopathological Changes.

BACKGROUND: Hypopigmentation is a troublesome often-permanent sequelae after burn injury, particularly in dark races. A number of methods have been described to treat this phenomenon. In this work, we are going to study the effect of E light (intensive pulsed light+radiofrequency+cooling) in repigmentation of partial thickness and full thickness burn wounds in adult patients and light microscopic changes of biopsy material at various stages of repigmentation. PATIENTS AND METHODS: In this study, 24 patients with postburn hypopigmentation were selected and E light was used, using different filters, according to the skin color. The intensive pulsed light fluence varied between 38 and 42 J. Radiofrequency fluencies varied between 6 and 10 J, and the spot diameter was 8 × 32 mm. Pulse durations of 2 to 7 milliseconds and pulse delays of 15 to 30 milliseconds were used on all patients.The patients were evaluated by comparing pretreatment and posttreatment photos. Skin biopsies were taken from depigmented area before and after interventions. Melanocytes were immunostained using Hwenty-four homatropine methylbromide 45 and were counted in ×200 magnification fields. Melanin can be demonstrated after staining with hematoxylin and eosin. RESULTS: Seventeen cases were evaluated as excellent, 4 cases were evaluated as good, and 3 cases were evaluated as fair, but all patients stressed that their wounds have been improved.Light microscopy at 6 weeks posttreatment also confirmed the increased melanocyte number per field in all cases. CONCLUSIONS: E light induced significant overall clinical improvement in postburn hypopigmentation, particularly when E light was applied early after burn.

One Stage Aesthetic and Functional Reconstruction of Major Lower Lip Defects.

INTRODUCTION: Multiple techniques have been used for reconstruction of large defects of the lower lip. However, some complications, such as microstomia, distortion of oral commissure, lip functional problems, and sensory loss might occur with these techniques. The aim of this work is to evaluate a new method of reconstruction of large lower lip defects after excision of squamous cell carcinoma. PATIENTS AND METHODS: Eighteen patients with lower lip squamous cell carcinomas were managed with this new technique of reconstruction using dermal fat flap, mucobuccal flap, and muscle transfer after excision of the tumor with 1-cm safety margin on both sides. The functional and aesthetic assessments were performed at least 6 months after surgery, and the results were compared statistically with a control group. RESULTS: Of the 18 patients, sensibility was normal in 16 (89%) and complete competence was determined in all cases (100%). In 17 patients (94%), complete and symmetric pouting and mouth-opening movements were ensured. Interlabial measurements would be better in all patients. Nasolabial asymmetry was detected in 1 patient (6%) and apparent mentolabial scar tissue was detected in 2 patients (11%). The new vermilion was of equal width to the upper lip vermilion in 15 patients (83%). CONCLUSIONS: Based on our results, this technique could be considered a good choice for repair of major lip defects. In addition, using this technique will give good aesthetic and functional results.