Scar formation after lower eyelid incision for reconstruction of the inferior orbital wall related to the lower eyelid crease or ridge in Asians

Background: Transcutaneous lower eyelid approaches are associated with a risk of postoperative scarring depending on the distance between the incision line and the lower eyelid margin. The lower eyelid crease of Caucasians corresponds to a ridge-shaped fold in young Asians. However, this relationship has not been sufficiently evaluated in the latter. The authors, therefore, investigated the location of the scar and the lower eyelid crease or ridge to find the optimal location for the incision line.Methods: This study included 60 out of 139 patients who underwent inferior orbital wall reconstruction through a lower eyelid skin incision between July 2019 and June 2020. According to the location of the scar, the patients were classified into three groups: group A ( ≥ 2 mm above the lower eyelid crease or ridge), group B (within the lower eyelid crease or ridge to 2 mm above the lower eyelid crease or ridge), and group C (within the lower eyelid crease or ridge to 2 mm below the lower eyelid crease or ridge). At 6 or 12 months after surgery, the Patient and Observer Scar Assessment Scale (POSAS) score was obtained, the distance between the lower eyelid margin and the scar (DMS) and the distance between the margins of the peripheral pupil and the lower eyelid (DMPE) were measured, and the occurrence of ectropion was evaluated.Results: Group B had the lowest POSAS score (A: 22.7 ± 8.0, B: 20.9 ± 2.4, C: 32.5 ± 4.1, p < 0.001). Linear regression analysis showed that the DMS was positively correlated with the POSAS score (p < 0.001) and that the risk of DMPE widening increased as the DMS decreased (p = 0.029). None of the patients had ectropion.Conclusion: When using the transcutaneous approach for inferior orbital wall reconstruction, the optimal incision site is within the lower eyelid crease or ridge to 2 mm above the lower eyelid crease or ridge.

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Comparison of Modifications in Flap Anastomosis Patterns and Skin Incision Types for External Dacryocystorhinostomy: Anterior-Only Flap Anastomosis with W Skin Incision versus Anterior and Posterior Flap Anastomosis with Linear Skin Incision

The Scientific World JOURNAL ◽

10.1155/2015/170841 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Burcu Dirim ◽

Selam Yekta Sendul ◽

Mehmet Demir ◽

Erdem Ergen ◽

Zeynep Acar ◽

...

Keyword(s):

Drainage System ◽

Skin Incision ◽

Success Rates ◽

Posterior Flap ◽

Assessment Scores ◽

Scar Assessment ◽

Significant Difference ◽

Group A ◽

External Dacryocystorhinostomy ◽

Group B

Purpose. To compare the outcomes of external dacryocystorhinostomy (E-DCR) by using two different flap anastomosis patterns and skin incision types.Methods. This study included 79 patients (88 eyes) with lacrimal drainage system disorders who underwent E-DCR surgery. Fifty eyes of 44 patients (group A) underwent E-DCR by suturing anterior and posterior flaps (H-flap) of the lacrimal sac with curvilinear skin incision whereas in 38 eyes of 35 patients (group B) DCR was performed by suturing only anterior flaps (U-flap) with W skin incision.Results. The success rate was evaluated according to lacrimal patency and scar assessment scores. Patency was achieved in 78 patients (88.6%). In terms of groups, patency was 44 eyes (88.0%) in group A and 34 eyes (89.5%) in group B. There was no statistically significant difference in the success rates of lacrimal patency between the two groups. Further, there was no statistically significant difference concerning cutaneous scar scores.Conclusion. Our study suggests that anastomoses of only anterior flaps or both anterior and posterior flaps have similar success rates; suturing only anterior flaps is easier to perform and shortens the operative time. In addition, W skin incision is a reasonable alternative to curvilinear incision for reducing scar formation.

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Is it safe to incise skin by monopolar electrocautery? A comparative study

International Surgery Journal ◽

10.18203/2349-2902.isj20192147 ◽

2019 ◽

Vol 6 (6) ◽

pp. 1931

Author(s):

Nimesh B. Thakkar ◽

Pranav Patel ◽

Gautam Sonagra

Keyword(s):

Skin Incision ◽

Healing Time ◽

Skin Wound ◽

Cosmetic Result ◽

Advantages And Disadvantages ◽

Study Results ◽

Group A ◽

Selection For ◽

Group B ◽

Monopolar Electrocautery

Background: The present study of evaluation of the use of electrocautery to incise the skin has been done to evaluate and assess basically. The advantages and disadvantages of the electrocautery to incise the skin when compared with that of scalpel. The results of the use of electrocautery on skin wound are then assessed to formulate the criteria for proper case selection for this procedure.Methods: A total of 100 patients were taken for this study. 50 patients underwent electrocautry monopolar mode incision (group A) who were compared with 50 scalpel incision patients (group B). Study was done from 01 January 2016 to 30 September 2017. Variables used in this study were complication like pain, lack of apposition and skin infection at the site of incision, pain, sinus formation and induration. This method was also evaluated with respect to following parameters: days of hospitalization, cosmetic result, rate of infection, wound apposition and requirement of secondary suturing.Results: As per our study, results are in favour of electrocautry by means of hemostasis. But we found that infection rate and complications are more with it. Moreover number of dressings required and hospital stay was also more with patient undergoing skin incision with electrocautry.Conclusions: For locally overlying healthy skin with no compromise of vascularity or any oedema and there is less fat, electrocautery use for skin incision can still be recommended for better cosmetic result and shorter healing time with less complication and rapid surgery.

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Comparison between scalpel incision and electrocautery incision in midline abdominal surgery: a comparative study

International Surgery Journal ◽

10.18203/2349-2902.isj20211817 ◽

2021 ◽

Vol 8 (5) ◽

pp. 1507

Author(s):

Amit Yadav ◽

Lakshman Agarwal ◽

Sumit A. Jain ◽

Sanjay Kumawat ◽

Sandeep Sharma

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Abdominal Surgery ◽

Wound Infection ◽

Skin Incision ◽

P Value ◽

Wound Area ◽

Significant Difference ◽

Group A ◽

Group B

Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.

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Energy-Based Devices Affect the Aesthetic Outcome of Cervical Thyroidectomy and Parathyroidectomy. A Retrospective Study

Surgical Technology Online ◽

10.52198/21.sti.39.gs1499 ◽

2021 ◽

Vol 39 ◽

Author(s):

Antonella Pino ◽

◽

Lorenzo Gasco ◽

Daqi Zhang ◽

Paolo Carcoforo ◽

...

Keyword(s):

Body Dysmorphic Disorder ◽

The Body ◽

University Hospital ◽

Aesthetic Outcome ◽

Aesthetic Result ◽

Scar Assessment ◽

Number Of Patients ◽

Group A ◽

Group B ◽

The Impact

Introduction: Thyroid and parathyroid diseases are very common. Most of these cases are in women and may be amenable to surgery. The patient’s perception that these are not life-threatening diseases leads them to expect an excellent aesthetic result, since the surgical incision area is clearly visible. Objective: To evaluate different scarring outcomes using three different energy-based devices (Harmonic Focus®, Johnson & Johnson, New Brunswick, NJ; Thunderbeat Open Fine Jaw®, Olympus Medical, Tokyo, Japan; LigaSure Small Jaw®, Medtronic, Dublin, Ireland) and to determine the impact of post-thyroidectomy/parathyroidectomy scars on the patient’s quality of life. Methods: One hundred female patients who underwent thyroidectomy or parathyroidectomy between September 2017 and September 2019 at the Endocrine and Minimally Invasive Surgery Department of Messina University Hospital were recruited. A retrospective analysis assessed the thickness of the cervical scar via ultrasound imaging, and the patient’s degree of satisfaction through the Patient and Observer Scar Assessment Scale (POSAS) and the Body Dysmorphic Disorder Questionnaire (BDDQ). Results: The patients were divided into three groups according to the energy-device used: group A (LigaSure SJ (n=38), group B (Harmonic F, n=32) and group C (Thunderbeat OFJ, n=30). The three groups were homogeneous with respect to number of patients, age and surgical procedures. The best aesthetic result, which correlated with the lowest scar thickness, was observed in group A; these patients were more satisfied than those in the other two groups. Moreover, correlations between scar thickness and quantitative variables (such as age or BMI) were not found in any of the groups. Conclusions: Based on the data collected and our experience, the LigaSure Small Jaw® (Medtronic) seems to offer the best aesthetic outcome in patients who undergo transverse cervicotomy for thyroid and parathyroid diseases. However, further prospective studies involving a greater number of cases are needed.

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Intraoperative and Postoperative Analgesia Using Intravenous Opioid, Clonidine and Lignocaine

Anaesthesia and Intensive Care ◽

10.1177/0310057x9402200103 ◽

1994 ◽

Vol 22 (1) ◽

pp. 15-21 ◽

Cited By ~ 31

Author(s):

M. de Kock ◽

P. Lavandhomme ◽

J. L. Scholtes

Keyword(s):

Side Effects ◽

Postoperative Analgesia ◽

Randomised Trial ◽

Skin Incision ◽

Time Interval ◽

Colonic Surgery ◽

Double Blind ◽

Group A ◽

Group B ◽

Group D

The postoperative analgesia afforded after colonic surgery by IV opioid, clonidine and lignocaine given intra- and postoperatively was evaluated. In a double-blind randomised trial, 80 male patients scheduled for colonic resection under general anaesthesia received fentany 15 μg.kg−1 at induction and another 4 μg.kg−1 before skin incision (group A) or fentanyl (same dose) plus clonidine 4 μg.kg−1 in 20 min + 2 μg.kg−1.h−1 (group B, C) or fentanyl plus clonidine (same dosage) plus lignocaine 2 mg.kg−1 before skin incision, repeated before peritoneal incision and retractor placement (group D). In the four groups, intraoperative boluses of fentanyl 2 μg.kg−1 were given in response to the painful stimulation of the procedure. Postoperative pain was managed with PCA delivering 2 mg morphine per request in group A, 1.5 mg morphine in group B, 1.5 mg morphine + 15 μg clonidine in group C and 1.2 mg morphine + 15 μg clonidine + 23 mg lignocaine in group D. Postoperative analgesia was assessed by recording the analgesic demands (met and unmet) and the dose of morphine delivered at 6, 12, 18, 24, 36 hours. Side-effects, pain and sedation analogue scores were also recorded. A nalgesic demands and delivered morphine dose were reduced, at any time interval considered, in groups B, C, D, compared with A (P <0.001). No differences were noted between the groups B, C, D. Pain analogue scores were better in groups B, C, D compared with group A (P <0.001). Sedation and side-effects were not increased in groups B, C, D. Intraoperative clonidine was the major determinant of the reduction in analgesic demands and morphine delivered. Lignocaine, at the dose used, failed to afford any additional benefit.

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A randomized controlled study of anterior lumbar plexus combined with parasacral sciatic nerve block under the guidance of ultrasound and nerve stimulator in elderly patients undergoing hip arthroplasty

10.21203/rs.3.rs-308699/v2 ◽

2021 ◽

Author(s):

Wei Wu ◽

Wen-hao Bu ◽

Hai-bin Huang ◽

Ying Mao ◽

Yong-xing Tan

Keyword(s):

Sciatic Nerve ◽

Elderly Patients ◽

Nerve Block ◽

Hip Arthroplasty ◽

Skin Incision ◽

Sciatic Nerve Block ◽

Lumbar Plexus ◽

Group A ◽

Group B ◽

First Time

Abstract Objectives: To explore the clinical application of anterior lumbar plexus combined with parasacral nerve block under the dual guidance of ultrasound and nerve stimulator in elderly hip arthroplasty.Methods: Forty elderly patients aged from 65 to 85 years old who underwent unilateral hip arthroplasty (Except for revision of hip joint) were randomly divided into two groups (n=20 in each group): ultrasound-guided anterior lumbar plexus combined with parasacral sciatic nerve block group (group A) and ultrasound-guided anterior lumbar plexus block group (group B). Both groups were assisted with sedation with different doses of dexmetopyrimidine and analgesia with different doses of sufentanil. Because the orthopaedic team of our hospital performed hip arthroplasty with mature technique and fixed operation time, the onset time of block in group An and B, heart rate and blood pressure at admission (T0), skin incision (T1), half hour after skin incision (T2) and skin suture(T3), intraoperative dosage ofdexmedetomidine and sufentanil, postoperative 1, 4, 8, 16, 24hVAS score and the first time of getting out of bed were recorded.Results: the heart rate and blood pressure at T1, T2 and T3 in group A were significantly lower than those in group B (P < 0.05). The amount of sufentanil used during operation in group), A was significantly lower than that in group B (P < 0.05). The postoperative scores of 1,4,8,16 and 24hVAS in group), A were significantly lower than those in group B (P < 0.05), and the time of getting out of bed for the first time after operation was shorter than that in group B (P < 0.05).Conclusion: compared with simple anterior lumbar plexus block, anterior lumbar plexus combined with parasacral sciatic nerve block in elderly patients with hip arthroplasty can make the intraoperative circulation more stable, the intraoperative dosage of opioids significantly reduced and the effect of early postoperative analgesia is better. it can also shorten the time for patients to get out of bed for the first time.

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Repeatability of ultrasound examination of the optic nerve sheath diameter in the adult cat: comparison between healthy cats and cats suffering from presumed intracranial hypertension

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x19898006 ◽

2020 ◽

Vol 22 (10) ◽

pp. 959-965 ◽

Cited By ~ 1

Author(s):

Maria Antonietta Evangelisti ◽

Giovanni Carta ◽

Giovanni P Burrai ◽

Maria Luisa Pinna Parpaglia ◽

Francesca Cubeddu ◽

...

Keyword(s):

Optic Nerve ◽

Intracranial Hypertension ◽

Linear Regression Analysis ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Nerve Sheath ◽

Group A ◽

The Mean ◽

Group B ◽

The Right

Objectives The objectives of this study were to test: (1) the repeatability of ultrasonographic examination of the optic nerve sheath diameter (ONSD) in the cat; (2) the association between the ONSD and age, sex and body weight in healthy cats; and (3) the difference in the ONSD between healthy cats and those suffering from presumed intracranial hypertension (ICH). Methods This study had a prospective, blinded, observational cross-sectional study design. Two groups of animals were considered: healthy cats (group A) and cats with a diagnosis of presumed ICH (group B). The ONSD was evaluated, measured and compared between the two groups via an ultrasonographic transpalpebral approach. Repeatability of the procedure was evaluated through the intraclass correlation coefficient (ICC). Data were statistically compared using the Student’s t-test and linear regression analysis. Results A strong inter- and intraobserver ICC indicating good repeatability was observed. The interobserver ICC was 0.965 ( P <0.05) for the right eye and 0.956 ( P <0.05) for the left eye. The intraobserver ICC was 0.988 ( P <0.05) and 0.984 ( P <0.05) for the right and left eyes, respectively. In healthy cats the mean ± SD ONSD was 1.23 ± 0.11 mm (range 1–1.47 mm) and 1.23 ± 0.10 (range 1–1.4 mm) for right and left eyes, respectively. The ONSD was not related to sex or weight; a weak relationship was observed with age. In group B, the mean ONSD was 1.68 ± 0.13 mm (range 1.5–1.9 mm) and 1.61 ± 0.15 mm (range 1.4–1.9 mm) for the right and left eyes, respectively. In group B, the ONSD was statistically significantly larger than in group A, the healthy cats ( P <0.001). Conclusions and relevance The transpalpebral ultrasonographic technique is a non-invasive, feasible and reproducible method to measure ONSD both in healthy cats and in cats suffering from suspected ICH.

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Asymmetric dimethylarginine, homocysteine and renal function – is there a relation?

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm.2005.199 ◽

2005 ◽

Vol 43 (10) ◽

Cited By ~ 5

Author(s):

Romana Široká ◽

Ladislav Trefil ◽

Daniel Rajdl ◽

Jaroslav Racek ◽

Hana Rusňáková ◽

...

Keyword(s):

Blood Donors ◽

Asymmetric Dimethylarginine ◽

Linear Regression Analysis ◽

Vascular Wall ◽

Multiple Linear Regression Analysis ◽

Homocysteine Concentration ◽

Group A ◽

Edta Plasma ◽

Positive Correlations ◽

Group B

AbstractThe adverse effect of hyperhomocysteinemia on the vascular wall can be partially explained by increasing plasma concentration of asymmetric dimethylarginine (ADMA), a potent inhibitor of nitric oxide synthase. The aim of the study was to compare ADMA and homocysteine levels in three groups of subjects: blood donors with normal homocysteine concentration (group A), patients with hyperhomocysteinemia and normal kidney function (group B) and hemodialysis patients who are known to be hyperhomocysteinemic (group C). Concentrations of homocysteine (enzymatic method), ADMA (enzyme-linked immunoassay) and creatinine (Jaffe method) in EDTA plasma were measured. Plasma ADMA levels were significantly higher in both groups with hyperhomocysteinemia (1.60±0.56μmol/L in group B, 1.81±0.57μmol/L in group C) when compared with those in blood donors (0.82±0.29μmol/L, p<0.001 in both cases). Significant positive correlations were found between concentrations of ADMA and homocysteine (r=0.42, p<0.0001), ADMA and creatinine (r=0.39 p<0.001), homocysteine and creatinine (r=0.69, p<0.0001), age and homocysteine (r=0.47, p<0.001), age and ADMA (r=0.57, p<0.001) and age and creatinine (r=0.37, p<0.001). Increased ADMA concentrations in hyperhomocysteinemic patients were confirmed, but multiple linear regression analysis showed that this significant correlation is only apparent due the dependence of both parameters on age.

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Bupivacaine scalp nerve block: hemodynamic response during craniotomy, intraoperative and post-operative analgesia

Asian Biomedicine ◽

10.2478/abm-2010-0031 ◽

2010 ◽

Vol 4 (2) ◽

pp. 243-251 ◽

Cited By ~ 10

Author(s):

Lawan Tuchinda ◽

Wanna Somboonviboon ◽

Kaew Supbornsug ◽

Sukhumakorn Worathongchai ◽

Supodjanee Limutaitip

Keyword(s):

Hemodynamic Response ◽

Skin Incision ◽

Morphine Consumption ◽

Arterial Blood ◽

Post Operative Pain ◽

Morphine Administration ◽

Group A ◽

Scalp Block ◽

Noxious Stimuli ◽

Group B

Abstract Background: Noxious stimuli during craniotomy may induce hypertension and tachycardia, giving rise to morbidity in patients with intracranial hypertension. Craniotomy is followed by moderate level of postoperative pain. Objective: Evaluate the effectiveness of scalp block on hemodynamic response to noxious stimuli, intraoperative fentanyl requirement and post-operative analgesia. Methods: Sixty patients undergoing elective craniotomy were randomly assigned to receive a scalp block with either 0.5% bupivacaine or 0.25% bupivacaine and 1:200,000 adrenaline (group A and B) or normal saline with 1:200,000 adrenaline (group C). Fentanyl 0.5 mcg/kg was administered for hemodynamic control. Intraoperative mean arterial blood pressure (MAP), heart rate (HR), fentanyl doses, and post-operative pain scores were recorded. Post-operative analgesia was provided by patient-controlled analgesia (PCA) morphine for 24 hours. Results: MAP was greater in group C than group A during pinning and incision (p <0.05), and was greater in group C than group B during pinning, incision and craniotomy (p <0.05). HR differences were not statistically significant between all groups (p >0.05). Intraoperative fentanyl requirement was significantly greater in group C compared with group A and B (p < 0.05). Pain score, time to the first morphine administration and total morphine consumption were not significantly different between all groups. Conclusion: Pre-incision scalp blocks using either 0.25% or 0.5% bupivacaine with 1:200,000 adrenaline were effective to prevent rising of MAP, but not HR in response to cranial pinning and skin incision, causing less intraoperative fentanyl requirement. However, they did not reduce post-craniotomy pain and morphine consumption.

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A prospective study of diathermy versus scalpel skin incision in abdominal surgery

International Surgery Journal ◽

10.18203/2349-2902.isj20194174 ◽

2019 ◽

Vol 6 (10) ◽

pp. 3554

Author(s):

Arun Kumar Gupta ◽

Tejinder Singh Dall ◽

Darpan Bansal

Keyword(s):

Prospective Study ◽

Harmonic Scalpel ◽

Skin Incision ◽

Recent Past ◽

Medical Sciences ◽

Power Set ◽

Group A ◽

Group B ◽

A Prospective Study ◽

Time Of Administration

Background: Various methods of skin incision have been identified in the recent past. Traditional skin incisions were made with stainless steel scalpel but recently electrocautery instruments like harmonic scalpel are also in use. With rise of seropositive cases, we aimed to evaluate whether the electrocautery can replace scalpel in operation theater, to avoid unfortunate injury to surgeons with scalpel. So we compared the usefulness of diathermy skin incision vs. scalpel skin incision in general surgical patients.Methods: This prospective study designed to include 120 patients admitted in the Department of General Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar and who were undergoing elective abdominal surgical procedures namely cholecystectomy, appendectomy and inguinal hernia repair etc. Patients were randomly allocated into 2 groups of 60 patients each. In Group A, incision were made with electrocautery on cut mode and power set to 60-70. In group B, skin incisions were made with scalpel.Results: No statistical difference was found between group A and group B with regard to time of administration of pain killer injection, seroma formation, discharge being noticed from wound in both groups. Moreover the results were statistically non-significant for vascularity, pigmentation and pliability of wound observed.Conclusions: We concluded that electrocautery can effectively and efficiently replace scalpel in operation theater.

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