BACKGROUNDThe true proliferation degree of burn and operation scars during their maturation was poorly defined. The objective of this study was to provide a quantitative evaluation of the proliferation degree of deep-partial thickness burn and surgical suture wound scars after wound healing and the accuracy of subjective judgment of scar types.

METHODSA total of 423 patients in the burn group and 667 patients in the suture wound group were enrolled in this study. Objective scar measurement (by negative-positive moulage) was carried out at 3, 6 and 12 months after wound healing in 1090 patients from different regions in China. The Kruskal-Wallis H test and chi-square test were used in the statistical analysis.

RESULTSThe median degrees of scar proliferation were 0.03 cm at 3 months, 0.03 cm at 6 months and 0 cm at 12 months in the burn group and 0.05 cm, 0.04 cm and 0.04 cm respectively in the suture wound group. At 3 and 6 months post wound healing, there was no significant difference in scar proliferation between the groups (P > 0.01). After 1 year, burn scars displayed evidence of atrophy (P < 0.01). Although the degree of scar proliferation differed among the four scar types (P < 0.01), the ranges of scar height in the four scar types largely overlapped when judged in a subjective manner, especially in proliferation and superficial scars.

CONCLUSIONSScar atrophy occurs after one year in burns, but not in the surgical suture wound group. It is important to take anti-scar therapy for surgical wounds as well as burn wounds. The various scar types could not be judged precisely in a subjective manner.

Adolescent ; Adult ; Burns ; complications ; Cicatrix ; pathology ; Humans ; Middle Aged ; Skin ; pathology ; Young Adult

Objective:This study aimed to explore the safety and feasibility of gasless transoral vestibular robotic resection of thyroglossal duct cysts. Methods:The clinical data of patients who underwent gasless transoral vestibular robotic resection of thyroglossal duct cysts at the Department of otolaryngology, Sun Yat-sen Memorial Hospital, Sun yat-sen university from September 2020 to May 2022 were analyzed. The operative time, blood loss, postoperative complications, postoperative pain score, postoperative aesthetic score, and recurrence were prospectively evaluated. Results:All patients completed the operation successfully and no case conversed to an open operation. The operation time was 104.00（95.00, 131.25） minutes, and the surgical blood loss was 15.00（10.00, 16.25） mL. The drainage volume was（59.71±9.20） mL. Postoperative pathology was consistent with thyroglossal duct cysts. There was no local reswelling, subcutaneous hematoma, emphysema, skin flap necrosis, infection and other complications. The postoperative hospital stay was 3.00（2.00, 3.00） days. Six patients had mild sensory abnormalities of the lower lip 3 months after surgery, and all patients were satisfied with the cosmetic outcomes. No recurrence was found during the 5-26 months follow-up. Conclusion:gasless transoral vestibular robotic resection of thyroglossal duct cysts is safe and feasible, with hidden postoperative scars and good cosmetic outcomes. It can provide a new choice for patients with thyroglossal duct cysts.
Humans ; Robotic Surgical Procedures ; Thyroglossal Cyst/pathology* ; Postoperative Complications ; Cicatrix/pathology* ; Pain, Postoperative

OBJECTIVETo explore the influence of dermal defect and fat dome structure destruction in burn wounds on the formation of hyperplastic scar.

METHODSFifty two wounds in 24 burn patients with deep partial thickness burn indicating tangential excision in the extremities were enrolled in the study, and they were divided into three groups according to the extent of exposure of dermal fat granules, i.e. A (without fat exposure), B (with little fat exposure) and C (with much fat exposure) groups. These three groups were subdivided into A1 (without grafting), A2 (grafting with razor thin skin), B1 (without grafting), B2 (with razor thin skin grafting), C1 (without grafting) and C2 (with split-thickness skin grafting) groups, with 9 wounds in each group. The dermal depth and exposure rate of the fat granules in each group were measured and analyzed by KS400 photography analysis apparatus. The follow-up conditions of the scars 6 months after operation were evaluated with Vancouver remark system by Vancouver score assessment.

RESULTSThere was obvious difference in the dermal depth and exposure rate of the fat granules among all the groups (P < 0.05 or 0.01). The fat exposure rate was positively correlated with the extent of the dermal defect (gamma = 0.554, P < 0.05). The Vancouver score in group A was lower than that in B and C groups (P < 0.05), while that in B1 group (3.714 +/- 2.498) was evidently higher than that in other groups (P < 0.01). The scar score was lowered when the wounds were grafted with the dermis with its thickness similar to the depth of the defect, The scar score was increased along with the elevation of fat exposure rate (P < 0.05).

CONCLUSIONThere was a positive correlation between the degree of dermal defect and that of hyperplastic scar after burns. The disruption of fat dome structure might also be an important factor in the scar development.

Adipose Tissue ; pathology ; Adult ; Burns ; complications ; pathology ; Cicatrix, Hypertrophic ; etiology ; pathology ; Dermis ; pathology ; Female ; Humans ; Male ; Middle Aged ; Wound Healing

Breast cancer developing from a surgical scar is rare; this type of malignancy has been reported in only 12 cases to date. Herein, we report on a 52-year-old female who developed infiltrating ductal carcinoma in a surgical scar following excision of a benign mass. Two years previously, the patient underwent surgery and radiotherapy for invasive ductal carcinoma of the contralateral breast. The initial appearance of the scar was similar to fat necrosis; it was observed to be progressively shrinking on follow-up sonography. On the two year follow-up ultrasound, the appearance changed, an angular margin and vascularity at the periphery of the scar were noted. A biopsy and subsequent excision of the scar were performed; the diagnosis of infiltrating ductal carcinoma of the scar was confirmed.
Breast Neoplasms/*etiology/pathology/surgery ; Carcinoma, Ductal, Breast/*etiology ; Cicatrix/*complications ; Female ; Foreign-Body Reaction/pathology ; Giant Cells/pathology ; Humans ; Middle Aged ; Papilloma, Intraductal/pathology/surgery

OBJECTIVETo compare the clinical effect of the double eyelid blepharoplasty with central minimal incision and with three minimal incisions. Methods: From Jul. 2010 to May 2012, 268 cases (Group A) received double eyelid blepharoplasty with central minimal incision, while 102 cases (Group B) underwent double eyelid blepharoplasty with three minimal incisions. Photos were taken immediately, and 1,2, 4, 8,12 weeks after operation. Operation time, recovery time and postoperative complications were evaluated and recorded. The operation time and recovery time were analyzed by Wilcoxon rank sum test. The postoperative complications were analyzed by chi square test. The satisfactory degree was analyzed by t test.

RESULTSThe operation time in Group A was (25.63 ± 3.74) min, compared with that (29.90 ± 4.13) min in Group B (Z = -8.011, P <0.01). Meanwhile, the recovery time in Group A was shorter than that in Group B (Z = -15.887, P <0.01). The occurrence rate of postoperative complications,including hematoma,recurrence and scar hyperplasia in Group A was also lower than that in Group B. At the same time, the satisfactory degree in Group A was(97.302 ± 1.764), which was higher than that(88.628 10.880) in Group B (t = 12.650, P <0.05).

CONCLUSIONSThe double eyelid blepharoplasty with central minimal incision, which is suitable for all cases except those who has serious blepharochalsais, has more advantages than double eyelid blepharoplasty with three minimal incisions.

Blepharoplasty ; adverse effects ; methods ; Cicatrix ; pathology ; Eyelids ; surgery ; Hematoma ; Humans ; Hyperplasia ; Photography ; Postoperative Complications ; Prospective Studies ; Recurrence

OBJECTIVETo evaluate the feasibility, maneuver and efficacy of plasma prostate electrovaporization system in the treatment of rectal cicatricial stenosis.

METHODSAccording to similar procedure of transurethral resection prostate(TURP), intrarectal cicatriclectomy was performed with plasma prostate electrovaporization system in 7 patients with rectal low cicatricial stenosis after rectal cancer treatment (5 patients with transabdominal low anterior resection,2 patients with 3-dimension precise radiotherapy) to remove obstruction and dilate enteric cavity.

RESULTSSeven patients underwent 12 operations, including one operation in 3 patients, two operations in 3 patients, 3 operations in one patient. Resected rectal cicatricial tissue ranged from 5 to 15 g. Mean operation time was 41 min (25 to 40). Operation successful rate was 100% without complications such as perforation, bleeding and infection. All the patients had smooth defecation.

CONCLUSIONPlasma prostate electrovaporization system is an effective treatment for rectal cicatricial stenosis with tiny trauma.

Aged ; Cicatrix ; complications ; Constriction, Pathologic ; etiology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Rectal Diseases ; etiology ; pathology ; surgery ; Rectal Neoplasms ; surgery

OBJECTIVETo explore the effects of pressure therapy on proliferation and apoptosis of cells in hypertrophic scar (HS) of burn patients.

METHODSTwenty patients who were hospitalized from September 2010 to September 2012 and started to wear pressure garment tailored by rehabilitation therapists over 20 hours a day beginning from two weeks after healing of burn wounds with the depth from deep partial-thickness to full-thickness (early stage of formation of HS) were set as pressure treatment group (PT). Another group of patients who were hospitalized in the same period with HS formed 3, 6, 12, 24 months (with 5 patients at each time point) after deep partial-thickness to full-thickness burns without receiving any treatment were set as control group. HS tissue samples from limbs and face were excised at post treatment month (PTM) 3, 6, 12, 24 in group PT (with 5 patients at each time point), and 2 to 3 days after admission in control group. Five patients out of the above-mentioned 40 patients were selected according to the random number table, and normal skin tissue samples from abdomen and thigh were also obtained to serve as normal control. The expressions of proliferating cell nuclear antigen (PCNA) in HS and normal skin tissue were determined with immunohistochemical staining. The apoptosis status was detected with situ end labeling technique. The mRNA expressions of P57(kip2) and Cyclin E were determined with real-time fluorescence quantification PCR. Data were processed with t test, one-way analysis of variance, or LSD test.

RESULTS(1) In normal skin tissue, PCNA-positive cells were observed in the epidermal basal layer and prickle cell layer. In group PT and control group, PCNA-positive cells were observed in the epidermal basal layer, prickle cell layer, lower part of the granular cell layer, and dermis of HS. The percentages of PCNA-positive cells in HS in group PT were respectively (40.4 ± 2.9)%, (28.2 ± 6.2)%, (9.9 ± 0.7)% at PTM 3, 6, 12, which were significantly lower than those of HS formed 3, 6, 12 months after wound healing in control group [(48.3 ± 4.7)%, (36.2 ± 3.2)%, (11.4 ± 0.9)%, with t values respectively 3.186, 2.559, 2.880, P values all below 0.05]. (2) In normal skin tissue, apoptotic cells were observed in the epidermal basal layer. In group PT and control group, apoptotic cells were observed in each layer of epidermis of HS. The apoptotic indexes of HS in group PT were respectively (20.4 ± 1.2)%, (26.1 ± 0.4)%, (26.6 ± 1.0)% at PTM 6, 12, 24, which were significantly higher than those of HS formed 6, 12, 24 months after wound healing in control group [(16.2 ± 1.5)%, (23.1 ± 2.0)%, (24.8 ± 1.1)%, with t values respectively -4.904, -3.366, -2.606, P < 0.05 or P < 0.01]. (3) The mRNA expressions of P57(kip2) of HS in group PT were respectively 3.87 ± 0.20, 8.60 ± 0.78, 10.00 ± 0.57 at PTM 3, 6, 12, which were significantly higher than those of HS formed 3, 6, 12 months after wound healing in control group (3.34 ± 0.15, 6.36 ± 0.29, 9.34 ± 0.12, with t values respectively -4.880, -6.014, -2.375, P < 0.05 or P < 0.01). The mRNA expression of P57(kip2) in normal skin tissue was close to those of HS in group PT at PTM 12, 24 and those of HS formed 12, 24 months after wound healing in control group (with P values all above 0.05). (4) The mRNA expressions of Cyclin E of HS in group PT were respectively 19.30 ± 0.18, 12.77 ± 0.30, 9.21 ± 0.18 at PTM 3, 6, 12, which were significantly higher than those of HS formed 3, 6, 12 months after wound healing in control group (19.79 ± 0.34, 15.41 ± 0.26, 9.47 ± 0.17, with t values respectively 3.186, 2.559, 2.880, P < 0.05 or P < 0.01). The mRNA expression of Cyclin E in normal skin tissue was close to those of HS in group PT at PTM 12, 24 and those of HS formed 12, 24 months after wound healing in control group (with P values all above 0.05).

CONCLUSIONSPressure therapy can accelerate the evolution process of HS through accelerating apoptosis and inhibition of cell proliferation, thereby scar proliferation is inhibited.

Adult ; Apoptosis ; Burns ; complications ; rehabilitation ; Cell Proliferation ; Cicatrix, Hypertrophic ; pathology ; therapy ; Compression Bandages ; Female ; Humans ; Male ; Pressure

Marjolin's ulcer is a rare malignancy arising from various forms of scars, mainly an old scar resulted from burn. The second most common origin is malignant degeneration arising from tissue within osteomyelitis fistulae. Not uncommonly, the lesions may arise secondary to ulcers due to venous insufficiency or pressure sores. The pathology of the majority of Marjolin's ulcer is a well-differentiated squamous cell carcinoma. The exact reason for an ulcer which undergoes a malignant transformation is unknown. The pathologic diagnosis is the gold standard. Surgery remains the preferred treatment after diagnosis is reached. Wide surgical excision with margins up to 2-3 cm has been suggested. The necessity of whether lymphatic dissection should be executed, or radiotherapy and chemotherapy following surgery is still in dispute. This article deals with the etiology of Marjolin's ulcer and its pathological grading, diagnosis, treatment, prognosis, and prevention, with a hope to provide some useful clinical information.
Burns ; complications ; Carcinoma, Squamous Cell ; etiology ; pathology ; surgery ; Cicatrix ; Humans ; Lymphatic Vessels ; Pressure Ulcer ; pathology ; surgery ; Prognosis ; Skin Neoplasms ; etiology ; pathology ; surgery ; Skin Ulcer

In repeat lumbar surgery for failed back syndrome, well organized fibrous scar tissue is often noted, binding together the dura, nerve roots, and paraspinal muscles. An animal experimental study was done to investigate the prevention of scar formation after lumbar laminectomy by using dacron and sodium hyaluronate. The experimental animals consisted of three groups: 1) control group, 2) D group (covering the laminectomy defect with dacron sheet), and 3) H group (covering the laminectomy defect with sodium hyaluronate gel). Animals were sacrificed at varying intervals (3-12 weeks) and the lumbar spines were evaluated with histologic preparations. Scar adhesion to the dura was most significantly suppressed in the D group, followed by the H group and the control group.
Animal ; Cicatrix/etiology/*prevention & control ; Connective Tissue/pathology ; Disease Models, Animal ; Dura Mater/pathology ; Hyaluronic Acid ; *Laminectomy ; Polyethylene Terephthalates ; Postoperative Complications ; Rabbits ; Support, Non-U.S. Gov't ; Surgical Mesh

OBJECTIVETo explore the methods for repair of facial and cervical scars after burn.

METHODSOne hundred and two patients with facial and cervical scars as a result of burn injury were repaired by unilateral or bilateral deltopectoral flaps after expansion with pedicles. First, facial scars were excised and contractures were released to restore eye, mouth and nose to normal anatomical position. The facial scar flaps were overturned to join with the pedicles of deltopectoral flap for closing the wounds. The residual wounds were repaired by delayed flaps without pedicles 3 weeks later.

RESULTSAmong 102 patients, the flaps survived well in 94 cases, and blood supply insufficiency was found in distal end of unilateral flap in 7 cases (depigmentation after primary healing ). Necrosis of unilateral flap occurred in one patient, and it healed after skin grafting.

CONCLUSIONExpanded deltopectoral flap is efficacious procedure for repair of massive cervical and facial scars.

Adolescent ; Adult ; Burns ; complications ; Child ; Cicatrix ; etiology ; surgery ; Face ; pathology ; Facial Injuries ; Humans ; Male ; Neck ; pathology ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; Thorax ; Young Adult