Mallory–Weiss syndrome complicated by severe aspiration pneumonitis in an infant

ABSTRACT A 1-month-old girl presented with hematemesis and dyspnea. A large amount of blood was aspirated through a nasogastric tube, and chest computed tomography showed bilateral centrilobular opacified lesions, which suggested aspiration pneumonitis due to upper gastrointestinal bleeding. Her respiratory condition exacerbated, and we initiated nitric oxide (NO) therapy. Bleeding stopped with conservative treatment. She was weaned off mechanical ventilation and extubated on Day 6 after admission. Afterward, upper gastrointestinal endoscopy showed a longitudinal linear scar indicative of Mallory–Weiss syndrome (MWS). MWS is rarely reported in early infancy since many of the risk factors are absent in infants. Patients with aspiration pneumonitis usually recover respiratory function within 24 h and severe respiratory failure is rare in aspiration pneumonitis. There are no pediatric case reports describing MWS with severe aspiration pneumonitis. Although MWS is a rare cause of neonatal hematemesis, patients can become severely ill and require multidisciplinary treatment.

Dermatofibroma Over The Scar – A Rare Entity

Dermatofibroma is a common benign dermal tumour of unknown aetiology. With varied clinical presentation mimicking keloid, desmoid tumour and leiomyoma, the diagnosis of Dermatofibroma sometimes become problematic from the clinician side. Here, we report a case of Dermatofibroma in a not so common site which was clinically diagnosed to be a keloid. But later, the lesion turned out to be a dermatofibroma on histopathological examination. In our patient, the lesion was a single smooth circumscribed nodule over the left side of the abdomen. The lesion had a linear scar on either side and on palpation; it was firm in consistency. It was initially diagnosed to be a keloid which even after multiple intra-lesional steroid injections, failed to show any results. This prompted us to search for an alternate diagnosis; hence lesion was excised and analyzed. The Histopathological examination revealed a circumscribed lesion in the dermis, composed of benign spindle-shaped cells arranged in a storiform pattern. These findings, as mentioned above, were consistent with a diagnosis of Dermatofibroma, which is a slow-growing tumour commonly seen in the extremities. The keloid like a presentation of Dermatofibroma, is one another example of how a similar morphological presentation may have two distinct diagnoses resulting in a delay in providing appropriate treatment.

Emerging Technologies in Scar Management: Remodeling of Post-surgical Linear Scar Using Microplasma Radiofrequency

Linear scar is a common problem in all fields of surgery as it leads to unpleasant appearance that is not socially acceptable. In particular, linear scars in the exposed areas such as face, neck, and upper extremities cause significant psychological disturbance to patients who need proper medical assistance to release their suffering. The author proposed tissue remodeling strategy on an existed linear scar using FMRT (fractional microplasma radiofrequency technology) to render gross view of a linear scar less visible or non-visible by changing the scar tissue architecture. Similar concept is also applied to the intervention of an early-stage wound to significantly alter the natural process of wound healing via FMRT-mediated change of the histological architecture of a wound, and thus to prevent the formation of a grossly visible linear scar. This chapter introduces the general background information, FMRT concept, and its application on linear scar treatment and prevention with the presentation of several typical cases.

Use of Tissue Expansion and Serial Z-plasty for Release of Neck Postburn Scar Contracture

Z-plasty is widely employed in plastic surgery and its mainly functions include elongation along the axis of the scar, dispersal, and realigning the scar within the lines of minimal tension. It is especially useful to release linear-scar contracture, yet difficult for wide scars. Here, we described a technique of tissue expansion followed by serial Z-plasty for several cases of severe postburn scar contracture. In this procedure, first, full expansion should be achieved in the tissues adjacent to the contracture by tissue expansion. Then, the serial Z-plasty technique with precise trimming and adjustment is performed with adequate tension-free skin to release the contracture. Over a period of 2 years from 2015 to 2017, this technique was employed in moderate or severe postburn scar contracture in four patients (1 male and 3 females) aged 14 to 40 years old. The size of contracture ranged from 5 to 27 cm in diameter. Improved appearance and excellent skin match was observed in our four patients. All patients healed uneventfully without any complications and no patient required revision surgery. The range of motion, short form-36 health survey and Vancouver Scar Scale indicated that this technique offered a durable skin coverage with satisfying appearance in these patients. Through the outcomes of our patients, tissue expansion followed by serial Z-plasty has a great potential to be a useful alternative for the treatment of scar contracture especially for contracture adjacent to cervical joints.

Comparative study between cyanoacrylate tissue adhesive versus skin sutures in closure of wound in 60 operated cases of open inguinal hernia

Background: Today there are numerous methods available for closure of wounds like tissue adhesives, staplers, adhesive tapes and obviously the age old conventional suturing, all of which have their own pros and cons. The aim was to study the complications and results of use of 2-octyl cyanoacrylate on wound healing and compare them without those of conventional suturing.Methods: Study included 60 operated cases of open inguinal hernia. And comparison was made between cyanoacrylate tissue adhesive and conventional skin suturing in open inguinal hernia.Results: 1 out of 30 (3.3%) from tissue adhesive group and 2 out of 30(6.7%) develop fever ( P value=1.000). 4 (13.3%) of tissue adhesive and 4 (13.3%)from suturing developed redness (P value=1.000). 4 (13.3%) tissue adhesive and 5 (16.7%) from suturing had discharge (P value=0.718). 2 (6.7%) and 1 (3.3%) developed wound dehiscence from tissue adhesive and suturing respectively (P value=0.554). 1 (3.3%) from tissue adhesive developed edge eversion (P value=0.313). 24 (80%) wounds are cosmetically good in which tissue adhesive was applied and 2(6.7%) in which suturing was done (P value=0.001) which is statistically significant.Conclusions: Time required for the intraoperative application of cyanoacrylate glue is less than suturing of incision.Incidence of wound infection was found to be less when wound closure done by cyanoacrylate glue in comparison to suturing. A single linear scar was obtained using cyanoacrylate glue which is cosmetically better than suture scar. Incidence of wound dehiscence is more in cases of application of cyanoacrylate glue than suturing.

Linear scar sarcoidosis on thin blepharoplasty line mimicking a hypertrophic scar: A case report

Sarcoidosis is a multisystem inflammatory disease of unknown aetiology. Skin involvement has been reported in 12%–27% of patients with systemic disease, and scar sarcoidosis is a form of sarcoidosis developing in previous cutaneous scar areas. Scars due to all kinds of trauma, including surgery, vaccines, cosmetic tattoos, and herpes zoster infection, have been reported to be associated with sarcoidosis. Upper eyelid blepharoplasty is a mainstay of aesthetic procedure and of surgical rejuvenation of the orbital region. There have been relatively few reported scar sarcoidosis on blepharoplasty scar, considering many blepharoplasty procedures done for the last century. We report a case of 47-year-old woman presented with abruptly forming bilateral scar sarcoidosis on upper eyelid linear scars of 20 years of duration.

Sweet’s Syndrome Arising in a Scar

Acute febrile neutrophilic dermatosis (Sweet’s syndrome) is an uncommon inflammatory cutaneous disorder. It presents with lesions which are tender, erythematous, edematous papules and under histologic examination show dense neutrophilic infiltration of the dermis. These lesions are often accompanied by leukocytosis and fever. This paper reports a unique case of acute febrile neutrophilic dermatosis presenting as a Koebner response to a linear scar.

Modified Octyl-2-Cyanoacrylate Tissue Adhesive for the Closure of Long Surgical Incisions

Long surgical incisions required application of more flexible cyanoacrylate adhesive to relieve skin tension. A new formulation of octyl-2-cyanoacrylate (OCA) was modified by 0%, 3%, 6% and 9% (w/v) polytrimethylene carbonate (PTMC). The OCA/PTMC adhesives showed higher viscosity and bond strength than OCA monomer. The OCA/6% PTMC adhesive plus subcutaneous suture was used as group A (Treatment group), and the OCA/6% PTMC tissue adhesive alone was used as group B (Control group). 30 days later, there was no apparent scar formation in group A. A linear scar formation still could be seen in group B. The results supported the use of OCA/6% PTMC adhesive alone or adhesive plus subcutaneous suture in long surgical incisions, and the latter maintained better scar formation.