Navigating Scar Care: An Evaluation of Scar Treatment Patient Education Materials.

While patient education materials (PEMs) across various specialties have been reported as being too difficult to read, the quality and understandability of PEMs related to scar management have not been assessed. In this study, we report the breadth of scar management interventions and readability of online PEMs authored by academic societies and university hospitals. Websites of academic medical societies and university hospitals with scar revision PEMs were assessed for relevance. PEM readability was assessed via Flesch Reading Ease, Flesch-Kincaid Grade Level, and Gunning-Fox Index scores. Understandability and actionability were evaluated using the Patient Education Material Assessment Tool (PEMAT). A total of 26 scar revision PEMs met the inclusion criteria. The most commonly mentioned scar management interventions were scar revision surgery (73%) and laser scar revision (70%), with minimal emphasis on non-invasive methods like scar massage or sun protection. Readability analysis yielded a mean Flesch reading level of 8.8. Overall PEMAT understandability of online scar treatment PEMs was moderate, with a median of 76.0% (IQR 71.5 - 80.5%). PEMs from all specialties and institution types were lacking in actionability, with median actionability of 40.8% (IQR 38.1-60.0%). Online scar revision PEMs included a wide breadth of scar management interventions, however the least costly interventions of sun protection and scar massage were not commonly included. PEMs for scar management could be improved by simplifying language, including visual aids, and including checklists or specific steps patients can take to take action on scar management interventions.

Aesthetic Reconstruction Based on Facial Subunit Principle for Basal Cell Carcinoma of the Face: A Retrospective Analysis.

Background and objective Basal cell carcinoma (BCC) is the most common malignancy of the skin. Reconstruction of post-excisional defects in BCC should follow the subunit principle for better outcomes. The location of BCC of the face is determined based on facial units; however, very few studies have described the involvement of multiple units and multiple subunits in BCC. In this study, we aimed to provide valuable insights into the management of BCC involving various facial units and subunits, thereby contributing to improved patient care and outcomes. Materials and methods We conducted a retrospective study at the Plastic Surgery Department of the SCB Medical College in Cuttack, Odisha, from January 2020 to January 2022, after obtaining ethical approval from the SCB Medical College IRB (no: 1155). We examined 35 patients with BCC of the face. The inclusion criteria were as follows: patients with early-stage and primary tumors that were mobile, not attached to underlying bone or cartilage, and amenable to surgical resection. Conversely, patients with late-stage, neglected, and recurrent tumors, fixed tumors, or those infiltrating the underlying bone or cartilage were excluded from the study. Data collection involved retrieving pertinent information from medical records, including parameters such as age, sex, tumor site, type of flap utilized, follow-up, and any complications observed. The tumor sites were further divided into six separate groups based on facial aesthetic units: the forehead, the nose, the area around the eyes, the cheek, the mouth, and the area around the ear, each with its own subunits. Results A total of 35 patients were included in this study, comprising 15 males (42.85%) and 20 females (57.15%), with a male-to-female ratio of 1:1.33. The ages of the patients ranged from 42 to 68 years. Among the facial units, the nose was the most commonly involved (in seven cases), while the lip was the least commonly affected (in one case). In 24 cases, a single unit was involved, while 11 cases involved multiple units. Furthermore, single subunits were affected in 18 cases, double subunits in 10 cases, three subunits in five cases, four subunits in one case, and five subunits in another case. Notably, no cases exhibited flap necrosis, wound dehiscence, wound hematoma, or seroma, indicating excellent surgical outcomes. All flaps remained viable, and all patients were followed up for a minimum of one year, with no reported recurrence during the follow-up period ranging from 6 to 18 months, reaffirming the effectiveness of the treatment approach. Conclusions For small, superficial lesions, full-thickness skin grafts (FTSG) are a suitable treatment option. However, when dealing with larger lesions that encompass multiple subunits, the preferred approach involves reconstructing with locoregional flaps. It is essential to plan the procedure carefully, taking into account the goal of positioning the final scar along the junction of facial subunits. This strategic plan aims to achieve superior aesthetic outcomes.

Application and effect of tension-reducing suture in surgical treatment of hypertrophic scar.

PURPOSE: To investigate the application and effectiveness of tension-reducing suture in the repair of hypertrophic scars. METHODS: A retrospective analysis of clinical data was conducted on 82 patients with hypertrophic scars treated at the Department of Burns and Plastic Surgery of Nanjing Drum Tower Hospital from September 2021 to December 2022. Patients were operated with combination of heart-shaped tension-reducing suturing technique and looped, broad, and deep buried (LBD) suturing technique or conventional suture method. Outcomes of surgical treatment were assessed before and 6 months after surgery using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS). RESULTS: Improvements were achieved on scar quality compared to that preoperatively, with a reduction in scar width (1.7 ± 0.6 cm vs. 0.7 ± 0.2 cm, P < 0.001). Assessment using the POSAS and VSS scales showed significant improvements in each single parameter and total score compared to preoperative values (P < 0.05). The Combination method group achieved better score in total score of VSS scale, in color, stiffness, thickness and overall opinion of PSAS scale, and in vascularity, thickness, pliability and overall opinion of OSAS scale. CONCLUSION: The amalgamation of the heart-shaped tension-reducing suturing technique and the LBD suturing technique has shown promising outcomes, garnering notably high levels of patient satisfaction in the context of hypertrophic scar repair. Patients have exhibited favorable postoperative recoveries, underscoring the clinical merit and the prospective broader applicability of this approach in the realm of hypertrophic scar management.

Evidence-based management of cutaneous scarring in dermatology part 2: atrophic acne scarring.

Atrophic acne scars are the most common type of acne scars and are classified into three main types: icepick, boxcar, and rolling scars. Various procedures and techniques for atrophic acne scarring are discussed in detail, with stronger evidence-based support for lasers (non-fractional, fractional, ablative, and non-ablative), platelet-rich plasma as adjunctive treatment, chemical peels (glycolic acid, trichloroacetic acid, and Jessner's solution), dermal fillers such as hyaluronic acid, and microneedling, and lesser quality evidence for microdermabrasion, subcision, and lipoaspirate grafting. Further research is needed to optimize treatment protocols, assess the efficacy of monotherapies, and establish standardized guidelines for clinicians. This paper will provide a comprehensive review of the evidence-based management of atrophic acne scars, including currently commonly utilized therapies as well as more innovative treatment options.

Influence of Moisturizers on Skin Microcirculation: An Assessment Study Using Laser Speckle Contrast Imaging.

Non-invasive scar management typically involves pressure therapy, hydration with silicones or moisturizers, and UV protection. Moisture loss from scars can lead to hypertrophic scar formation. Pressure therapy reduces blood flow, fibroblast activity, and transforming growth factor beta 1 (TGF-ß1) release. This study examined various moisturizers and liquid silicone gel's impact on microcirculation. 40 volunteers participated in a study where superficial abrasions were created to induce trans epidermal water loss (TEWL). Five moisturizers (TEDRA®, TEDRA® NT1, TEDRA® NT3, Alhydran®, Lipikar®) and BAP Scar Care® silicone gel were tested. TEWL, hydration, and blood flow were measured up to 4 h post-application. Results showed that silicone had the least impact on occlusion and hydration. Alhydran® reduced blood flow the most, while Lipikar® increased it the most. TEDRA® NT1 had reduced flow compared to TEDRA® and TEDRA® NT3. All TEDRA® products exhibited high hydration, and all but silicone showed good occlusion. Moisturizers influenced skin microcirculation, with some causing decrease, while others increased flow. However, the clinical impact on scarring remains unclear compared to the evident effects of hydration and occlusion. More research is necessary to study moisturizers alone and with pressure therapy on scars, along with potential adverse effects of increased microcirculation on scars.

Which Moisturizer to Use in Scar Therapy after Burn Injuries? A Subjective and Objective Skin and Scar Evaluation after Topical Treatment with Dexpanthenol, Aloe Vera, and Plant Oil.

Background and Objectives: Good scar management in burn care is essential. Nevertheless, there are no consistent recommendations regarding moisturizers for scar management. Our aim was to investigate and compare the effects of commonly used products on normal skin and burn scars. Materials and Methods: A total of 30 skin-healthy (control group) and 12 patients with burn scars were included in this study. For an intraindividual comparison, each participant received creams consisting of dexpanthenol (P), aloe vera (A), and a natural plant oil (O) with instructions to apply them daily to a previously defined area for at least 28 days. Objective scar evaluation was performed with Visioscan®; Tewameter®; Cutometer®, and the Oxygen To See® device. Subjective evaluation was performed with an "application" questionnaire, the Patient and Observer Scar Assessment Scale (POSAS), and with the "best of three" questionnaire. Results: After (A) a high trend of amelioration of +30%, TEWL was detected on the scar area. Blood flow increased slightly on healthy skin areas after (A) application to +104%. The application of (A) on healthy skin demonstrated a positive effect on the parameters of scaliness (+22%, p < 0.001), softness (+14%, p = 0.046), roughness R1 (+16%, p < 0.001) and R2 (+17%, p = 0.000), volume (+22%, p < 0.001), and surface area (+7%, p < 0.001) within the control group. After (P), a significant improvement of the baseline firmness parameter of +14.7% was detected (p = 0.007). (P) also showed a beneficial effect on the parameters of R1 (+7%, p = 0.003), R2 (+6%, p = 0.001), and volume (+17%, p = 0.001). (O) lead to a statistically significant improvement of volume (+15%, p = 0.009). Overall, most study participants stated (A) to be the "best of three". Conclusions: (A) performed statistically best, and is a well-tolerated moisturizing product. However, further quantitative studies are needed to provide statistically significant clarification for uniform recommendations for scar therapy.

Meek Micro-Skin Grafting and Acellular Dermal Matrix in Pediatric Patients: A Novel Approach to Massive Extravasation Injury.

(1) Background: Extravasation injuries in pediatric patients can lead to significant harm if they are not promptly diagnosed and treated. However, evidence-based standardization on extravasation management remains limited, particularly for extensive wound necrosis. This case report presents the management of an 8-week-old premature patient with an extensive extravasation injury involving the right forearm and dorsum of the hand. (2) Methods: The patient was evaluated by a multidisciplinary team in our Neonatal Intensive Care Unit. Surgical intervention involved the debridement of necrotic tissues, followed by temporary coverage with an acellular dermal matrix. Definitive coverage was achieved through Meek micrografting after three weeks. Physical therapy was provided with pre- and post-rehabilitation range of motion assessed using goniometric measurements. Scar quality was evaluated using the Vancouver Scar Scale. (3) Results: The engraftment rate of the Meek micrografts was 93%, with 16 out of 226 micrografts lost. The patient achieved a Vancouver Scar Scale score of 6, indicating a moderate degree of scarring. Significant improvements in elbow, wrist, and finger joint range of motion were observed at a 1-year follow-up. (4) Conclusions: Close observation and heightened awareness of extravasation risks by trained personnel are crucial. Meek micrografting combined with dermal substitute coverage represents an innovative approach to managing extravasation wounds in pediatric patients.

Burn Scar Management and Reconstructive Surgery.

This chapter highlights the importance of a comprehensive burn scar treatment plan in approaching a burn survivor. General concepts of burn scar physiology and a practical system to describe burn scars based on cause, biology, and symptoms are presented. Common scar management modalities including nonsurgical, surgical, and adjuvant therapies are further discussed.

Impact of internal mammary artery perforator propeller flaps combined with radiotherapy in the treatment of large chest keloids: Our experience.

Background: Keloids are benign skin hyperplasias but have a tumor-like appearance. Clinical management of keloids remains challenging. Aims: We retrospectively evaluated the safety and efficacy of internal mammary artery perforator propeller flaps combined with timely radiotherapy in the treatment of large chest keloids. Methods: From June 2017 to May 2020, 25 patients with large chest keloids (average size 4.82 cm ± 2.53 cm × 9.04 cm ± 4.86 cm) who received both radiotherapy and internal mammary artery perforator flaps transplantation in our department were included. After surgical removal of the keloids, various propeller flaps based on the unilateral internal mammary artery were designed and applied to repair the defects. Timely and full-dose radiotherapy was performed for these patients after the operation. Results: After keloid resection, the dimensions of the defect area were 3 cm-15 cm × 4 cm-25 cm, and the sizes of the flaps were 3 cm-16 cm × 4 cm-27 cm. For all 25 patients, the flaps survived, and the incisions healed in one stage. During the follow-up (median 18 months), no local recurrence was observed, and the itching and pain symptoms in the scar area were significantly relieved. Both physicians and patients were satisfied with the results. Conclusions: The application of internal mammary artery perforator propeller flaps combined with radiotherapy in the treatment of chest keloids can effectively reduce the recurrence of keloids and relieve the related symptoms. It also has advantages including minimized donor site damage, short operation time and speedy postoperative recovery, suggesting its great clinical value.

Pressure therapy for scars: Myth or reality? A systematic review.

BACKGROUND: Hypertrophic scarring is a deviate occurrence after wound closure and is a common burn sequela. The mainstay of scar treatment consists of a trifold approach: hydration, UV-protection and the use of pressure garments with or without extra paddings or inlays to provide additional pressure. Pressure therapy has been reported to induce a state of hypoxia and to reduce the expression pattern of transforming growth factor-ß1 (TGF-ß1), therefore limiting the activity of fibroblasts. However, pressure therapy is said to be largely based on empirical evidence and a lot of controversy concerning the effectiveness still prevails. Many variables influencing its effectivity, such as adherence to treatment, wear time, wash frequency, number of available pressure garment sets and amount of pressure remain only partially understood. This systematic review aims to give a complete and comprehensive overview of the currently available clinical evidence of pressure therapy. METHODS: A systematic search for articles concerning the use of pressure therapy in the treatment and prevention of scars was performed in 3 different databases (Pubmed, Embase, and Cochrane library) according to the PRISMA statement. Only case series, case-control studies, cohort studies, and RCTs were included. The qualitative assessment was done by 2 separate reviewers with the appropriate quality assessment tools. RESULTS: The search yielded 1458 articles. After deduplication and removal of ineligible records, 1280 records were screened on title and abstract. Full text screening was done for 23 articles and ultimately 17 articles were included. Comparisons between pressure or no pressure, low vs high pressure, short vs long duration and early vs late start of treatment were investigated. CONCLUSION: There is sufficient evidence that indicates the value of prophylactic and curative use of pressure therapy for scar management. The evidence suggests that pressure therapy is capable of improving scar color, thickness, pain, and scar quality in general. Evidence also recommends commencing pressure therapy prior to 2 months after injury, and using a minimal pressure of 20-25 mmHg. To be effective, treatment duration should be at least 12 months and even preferably up to 18-24 months. These findings were in line with the best evidence statement by Sharp et al. (2016).

Epidemiological and clinical features of paediatric inpatients for scars: A retrospective study.

OBJECTIVES: To describe the epidemiological and clinical features of paediatric scar inpatients and then to facilitate therapeutic schedule for children with scars. METHODS: In this cross-sectional study, data of patients admitted for scar treatment in 1064 tertiary hospitals from 2013 to 2018 were extracted through the Hospital Quality Monitoring System (HQMS) database. Demographic and clinical features of children with scars were analysed statistically and highlighted compared with those of adults and the elderly scar cases. RESULTS: In this study, 53,741 paediatric scar cases, accounting for 30.29% of all hospitalized for scar, were analysed. Compared to adults and the elderly, children with scars were mainly males (62.27% vs 50.98% vs 49.85%, P < 0.001) and were vulnerable to scalds (37.10%) and operative intervention (34.11%). Although the scalp/face/neck was the most common affected location, the proportion of scars involving upper limbs (27.88% vs 21.69% vs 7.28%, P < 0.001), lower limbs (15.14% vs 10.28% vs 6.56%, P < 0.001) and perineum (4.59% vs 3.13% vs 2.65%, P < 0.001) was higher in children than that in other two groups. Scar contracture was the most common complications in children (45.27%). Nearly 66% of paediatric scar cases received surgical treatment during hospitalization, among whom release of lesion was the most frequent operation (56.35%). The proportion of keloids was relatively lower in child cases than in other two groups (6.20% vs 14.48% vs 18.15%, P < 0.001). Additionally, the median LOS in child cases was 9 (5-15) days, slightly exceeding that in adult/elderly cases. CONCLUSIONS: Scars were common inducing factors of hospitalization and contributed greatly to the disease burden of children. More attention should be paid to those who are males, burn survivors, or skin-injured at extremities and perineum to improve therapeutic strategies and prognoses for paediatric scar patients.

Hypertrophic scar management.

Scarring has major psychological and physical repercussions. Scars are often considered trivial, but they can be disfiguring and aesthetically unpleasant and may cause severe itching, tenderness, pain, sleep disturbance, anxiety, depression and disruption of daily activities. It is more efficient to prevent hypertrophic scars than treat them; early diagnosis of a problem scar can considerably impact the overall outcome. Therefore, nurses need to be as knowledgeable about scar products as they are about wound products, and their responsibility should not end once the wound has healed. Appropriate management of the scar will ensure that the wound remains healed and that the patient is happy with the outcome. The nurse is ideally placed to ensure that scars are appropriately identified and treated as early as possible.

Deep and extensive pediatric burns: retrospective evaluation of scheme of patients at the Department of Children's Developmental Defects Surgery and Traumatology SUM.

<b> Introduction:</b> Burns are one of the most common injuries among children. Despite the scale of the problem, there is no generally accepted algorithm for dealing with burn wounds in children in Poland. </br></br> <b>Aim:</b> The aim of our study was to evaluate our treatment scheme as well as the long-term effects of burn treatment in our department. </br></br> <b>Material and methods:</b> We conducted a telephone survey with the parents of patients treated at our ward in 01.01.2016-01.01.2021 due to thermal burns. To assess the cosmetic effect of treatment, the modified Vancouver Scar Scale (mVSS) was used, as well as the evaluation of parents' satisfaction with the treatment of patients on a scale from 1 to 10. Criteria to be included were the thermal burn of the skin to at least a 2b degree and/or burns with not less than 8% of the Total Body Surface Area (TBSA), as well as answering all the questions included in the questionnaire. The inclusion criteria were met by 38 out of 97 hospitalized patients. </br></br> <b>Results:</b> 26.32% of patients achieved 0 points on the mVSS, 21.05% achieved 1 point, 15.79% achieved 2 points, 15.79% achieved 3 points, 2.63% patients received 4 points, 5.26% patients received 5 points, 5.26% patients received 7 points, 2.63% patients received 8 points, 2.63% patients received 9 points, 2.63% of patients received 10 points, none of the patients received 6 and 11 points higher. 3% of parents rated their satisfaction at 5 points, 3% of caretakers as 7 points, 8% as 8 points, 8% as 9 points, and 89% as 10 points. </br></br> <b>Discussion:</b> Our treatment algorithm brings good therapeutic effects and is also very well received by the patients' parents. In order to carry out a nationwide standardization of the treatment of childhood burn wounds, it would be necessary to conduct a similarly constructed study in a multicenter setting.

Is massage an effective intervention in the management of post-operative scarring? A scoping review.

BACKGROUND: Scar massage is a widely used treatment modality in hand therapy. This intervention is thoroughly discussed in the literature relating to burns rehabilitation, however, the evidence for its use in treating linear scars following surgery is limited. PURPOSE OF STUDY: To collate the empirical literature on scar massage for the treatment of postsurgical cutaneous scars. STUDY DESIGN: Scoping review. METHODS: Medline, EMBASE, CINAHL, AMED, Scopus, ProQuest Dissertations & Theses Global, and the Joanna Briggs Institute were searched from inception to December 2020. Two researchers used a data extraction tool to record key demographic, intervention and outcome data, and to apply the Oxford Levels of Evidence for each study. RESULTS: Twenty-five studies met the inclusion criteria, reporting on a combined sample of 1515 participants. Only two papers addressed hand or wrist scars (92 participants). While all studies reported favorable outcomes for scar massage, there were 45 different outcome measures used and a propensity towards non-standardized assessment. Intervention protocols varied from a single session to three treatments daily for 6 months. The results from 13 studies were confounded by the implementation of additional rehabilitation interventions. CONCLUSIONS: The overall findings suggest that while there may be benefits to scar massage in reducing pain, increasing movement and improving scar characteristics; there is a lack of consistent research methods, intervention protocols and outcome measures. This scoping review highlights the heterogenous nature of research into scar massage following surgery and supports the need for further research to substantiate its use in the clinical setting.

The Effectiveness of Plasma Skin Regeneration (PSR) in the Treatment of Chronic Cleft Lip Scars in an Adult Syrian Sample: A Cohort Study on a Novel Technique.

Objectives The current study aimed to evaluate the effectiveness of plasma skin regeneration (PSR) in the treatment of cleft lip scars in cleft lip patients.  Materials and methods Twenty patients, 10 females and 10 males, with a mean age of 19 years and who had a cleft lip scar, were included in the current study. All patients were treated with a plasma skin regeneration pen device in one treatment session. The thickness, relief, and pliability of the scars were assessed by external observers using a 10-point numeric rating scale (NRS). Results The thickness, relief, and pliability of the scar were significantly improved according to the observers' opinions (51.67%, 50.25%, and 46.33%, respectively). Conclusions Within the limits of this study, the PSR appeared to be safe and effective for treating cleft lip scars with minimal complications.

Facial Scar Management by Hair Transplant: A Case Report.

Facial scars in hair-bearing areas are a difficult problem to deal with owing to the nature of the scar tissue and the poor survivability of the grafts. A 26-year-old male presented with a scar on the right cheek area. The patient complained of recurrence and widening of scar and resultant facial asymmetry after serial excision in another hospital. The scar was the result of a burn injury sustained 15 years back. The scar was managed by using 2,642 hair grafts harvested from the scalp area. The patient had excellent hair growth at the end of 1 year with a high satisfaction level. There was a visible improvement in the lip deviation. Restoration of hair in the hair-bearing region of the face may be considered a permanent single-stage solution in such patients.

Effectiveness of topical silicone gel and pressure garment therapy for burn scar prevention and management in children 12-months postburn: A parallel group randomised controlled trial.

OBJECTIVE: The longer-term effectiveness of silicone and pressure burn scar interventions was evaluated at 12-months postburn. DESIGN: Parallel group, randomised trial. SETTING: Hospital outpatient clinics, research centre. PARTICIPANTS: Children referred for burn scar management following grafted or spontaneously healed acute burn injuries or scar reconstruction surgery. INTERVENTIONS: Participants were randomised to: (1) topical silicone gel only, (2) pressure garment only, or (3) combined topical silicone gel and pressure garment. MAIN MEASURES: Primary outcomes were scar thickness (blinded ultrasound measurement) and itch intensity (caregiver proxy-report, numeric rating scale). RESULTS: Of 153 participants randomised who received the interventions (silicone n = 51, pressure garment n = 49, combined n = 53), 86 were followed-up at 12-months postburn (n = 34, n = 28, n = 24). No differences were identified for the primary outcomes using intention-to-treat analysis. Scar thickness mean difference (95% confidence interval) = 0.00 cm (-0.04, 0.05); -0.03 cm (-0.07, 0.02); 0.03 cm (-0.02, 0.08) and scar itch = 0.09 (-0.88, 1.06); -0.21 (-1.21, 0.79); 0.30 (-0.73, 1.32) for silicone vs pressure; silicone vs combined and combined vs pressure respectively. No serious adverse effects occurred. CONCLUSION: Similar to short-term results, the combined intervention offered no statistically or clinically significant benefit for improving the primary outcomes compared to each intervention alone. No differences in the primary outcomes were identified between the silicone and pressure alone groups.

Calcium Electroporation for Keloids: A First-in-Man Phase I Study.

BACKGROUND: Keloid scarring is a pathologic proliferation of scar tissue that often causes pruritus, pain, and disfigurement. Keloids can be difficult to treat and have a high risk of recurrence. Recent studies have shown promising results in the treatment of cutaneous metastases with intralesional calcium combined with electroporation (calcium electroporation). As calcium electroporation has shown limited side effects it has advantages when treating benign keloid lesions, and on this indication we performed a phase I study. METHODS: Patients with keloids were treated with at least 1 session of calcium electroporation and followed up for 2 years. Calcium was administered intralesionally (220 mM) followed by the application of eight 100-µs pulses (400 V) using linear-array electrodes and Cliniporator (IGEA, Italy). Treatment efficacy was evaluated clinically (size, shape, erythema), by patient self-assessment (pruritus, pain, other) and assessed histologically. RESULTS: Six patients were included in this small proof of concept study. Treatment was well tolerated, with all patients requesting further treatment. Two out of 6 patients experienced a decrease in keloid thickness over 30%. A mean reduction of 11% was observed in volume size, and a mean flattening of 22% was observed (not statistically significant). Five out of 6 patients reported decreased pain and pruritus. No serious adverse effects or recurrences were observed over a mean follow-up period of 338 days. CONCLUSION: In this first phase I clinical study on calcium electroporation for keloids, treatment was found to be safe with minor side effects. Overall, patients experienced symptom relief, and in some patients keloid thickness was reduced.

Radial Scar: a management dilemma.

Radial scar (RS) or complex sclerosing lesions (CSL) if > 10 mm is a benign lesion with an increasing incidence of diagnosis (ranging from 0.6 to 3.7%) and represents a challenge both for radiologists and for pathologists. The digital mammography and digital breast tomosynthesis appearances of RS are well documented, according to the literature. On ultrasound, variable aspects can be detected. Magnetic resonance imaging contribution to differential diagnosis with carcinoma is growing. As for the management, a vacuum-assisted biopsy (VAB) with large core is recommended after a percutaneous diagnosis of RS due to potential sampling error. According to the recent International Consensus Conference, a RS/CSL lesion, which is visible on imaging, should undergo therapeutic excision with VAB. Thereafter, surveillance is justified. The aim of this review is to provide a practical guide for the recognition of RS on imaging, illustrating radiological findings according to the most recent literature, and to delineate the management strategies that follow.

Immediate fat and nanofat-enriched fat grafting in breast reduction for scar management.

BACKGROUND: Reduction mammoplasty can be successful but surgical scars may continue to be a most undesirable and unavoidable outcome. Various medical and non-invasive methods are available to minimize scar formation but as yet no methods have been discovered to eliminate them. We hypothesize that immediate fat and nanofat-enriched fat graft transfer may improve the scar quality and optimize results. MATERIALS AND METHODS: This prospective study comprised 45 superomedial pedicle wise-pattern breast reduction patients divided into three groups of 15 in a randomized fashion. The control group had no additional injections whereas the other two groups received injections of fat and nanofat-enriched fat grafts immediately under their surgery scars, respectively. Surgical scar formation was evaluated at six months and scars were scored using the Vancouver scar scale and a visual analogue scale. RESULTS: Fat and nanofat-enriched fat graft-injected groups scored significantly better on all items of the Vancouver scar scale, except for scar height, compared to the control group (p < 0.05). Visual analogue scores were significantly lower in the fat and nanofat-enriched fat graft-injected groups compared to the control group (p < 0.05). CONCLUSIONS: In breast reduction patients, simultaneous fat and nanofat-enriched fat grafting appears to be a safe and promising strategy for scar management.