Prediction of the relationship of cesarean section scar niche and postmenstrual spotting: is there any relation?

Background Postmenstrual spotting has recently been related to a discontinuation of the myometrium at the site of a previous cesarean section called "CS scar niche". There was no consensus regarding the gold standard method for the assessment of the niche. Recently, Magnetic resonance imaging (MRI) has shown promise in the evaluation of the niche. Our study aims to assess the role of MRI in the evaluation of the CS scar niche characters and its association with post-menstrual spotting. Results A total of 65 patients with CS niche were prospectively included in this study and subdivided into two groups, according to presence or absence of postmenstrual spotting (Group A; 34 patients with postmenstrual spotting and Group B; 31 patients without spotting). All patients were examined using a 1.5 T MRI unit. CS scar niche volume was significantly higher among women with post-menstrual spotting (0.57 ± 0.07 vs. 0.07 ± 0.05 (cm3); P < 0.001). Also, women with post-menstrual spotting have significantly higher scar length (9.38 ± 3.06 vs. 5.02 ± 2.10 (mm); P < 0.001), scar depth (6.95 ± 3.16 vs. 3.23 ± 0.99 (mm); P < 0.001), scar width (15.78 ± 3.94 vs. 9.87 ± 1.84 (mm); P < 0.001) in comparison to those without post-menstrual spotting. Scar depth (> 7.4 mm) had 81% sensitivity and 97% specificity for prediction of post-menstrual spotting with overall accuracy was 88.7%. While scar width (> 12.8 mm) had 71% sensitivity and 97% specificity for prediction of post-menstrual spotting with overall accuracy was 83.3%. Scar volume (> 0.15 cm3) had 97% sensitivity and 100% specificity for prediction of post-menstrual spotting with overall accuracy was 98.4%. Conclusion MRI measures (CS scar volume, depth, and width) are predictors for postmenstrual spotting in patients with CS scar niche, and scar volume is the most powerful predictor.

Scar Prevention With Prolonged Use of Tissue Adhesive Zipper Immediately After Facial Surgery: A Randomized Controlled Trial

Background Postsurgical scar management significantly affects patient satisfaction. However, reliable skin support options are limited. Objectives The present study aimed to determine the efficacy and safety of using tissue adhesive zippers in postsurgical scar prevention among patients undergoing surgical excision of the face. The primary outcome was a reduction in scar width, which was evaluated 1, 3, 6, and 12 months postoperatively. Scar width at month 12 was considered the final outcome. Methods This was a prospective, randomized, controlled, rater-blinded trial. Sixty-four patients were randomly assigned to two groups (zip group, defined as those using a tissue adhesive zipper for 3 months after surgery, and the control group). Outcomes were evaluated based on scar width and scale at 1, 3, 6, and 12 months postoperatively. Skin irritation was monitored during the first 3 months after surgery. The incidence of hypertrophic scar formation was recorded at a 12-month follow-up. Results Scar width differed significantly between the zip (1.68±0.45 mm) and control groups (2.15±0.64 mm). The scars spread rapidly in the first month after surgery but slowed down and stabilized after 6 months. The scale scores of the zip group were significantly lower than those of the control group. Neither group experienced significant complications. Conclusions Prolonged use of tissue adhesive zippers immediately after surgery reduced scar width and improved scar appearance without obvious side effects.

Tribological Properties of Al2O3 Nanoparticles as Lithium Grease Additives

The tribological properties of Lithium grease specimens with different concentrations of Al2O3 nanoparticles were investigated using a pin on disc apparatus under different sliding speeds and normal loads. Results showed that Al2O3 nanoparticles enhanced the tribological properties of lithium grease and reduced the COF and wear scar width by approximately 57.9% and 47.5% respectively.

Abstract 15215: Pro-pace: Prospective Randomized Trial of Skin Closure for Pacemaker Implant

Introduction: Pacemaker implantation is a standard technique with largely traditional knowledge and has been performed for over 50 years. Despite its huge distribution, there are hardly any randomized trials regarding technical aspects such as material of skin closure. Hypothesis: The aim was to compare if resorbable subcuticular suture skin is superior in terms of clinical or cosmetic endpoints vs. non-resorbable suture. Methods: We performed a prospective randomized comparison of non-resorbable subcuticular suture to suture with resorbable material for pacemaker implantation with indications according to current guidelines. All consecutive patients undergoing placement of pacemakers were eligible. Follow-up was 1 year. Scars were observed at day 1, week 6 and 1 year after surgery. Clinically relevant primary endpoints were: bleeding, infection or revision. Secondary endpoints recorded at day 1 were: local hematoma formation > 10cm diameter, wound width, insufficient skin closure. Secondary endpoints at 6 weeks and 1 year: scar width, pathological scarring with kelloid, insufficient skin closure. Cosmetic results were assessed using “ P atient and O bserver S car A ssessment score (POSA)“. Results: We included 115 pts. (77 male) and performed non-resorbable skin closure in 50 cases. There were no differences in clinical characteristics between patient groups. At 1 day after implantation was no difference between regarding clinical or cosmetic endpoints (Scar width P=0.43, POSA P=0.44). At 6 weeks and 1 year post implantation, there were similarly no differences in clinical or cosmetic endpoints between both groups (Scar width P=0.54, POSA P=0.45, figure). No relevant clinical endpoints (bleeding, infection, revision) were associated to either technique of skin closure. Conclusions: Based on the present prospective randomized study, suture material does not influence clinical or cosmetic results of pacemaker implantation.

Efficacy and Safety of Botulinum Toxin Type A in Preventing Postoperative Scars and Improving the Cosmetic Appearance of Scars: A Systematic Review and Meta-Analysis

Background Scars with poor cosmesis that develop after wound healing may affect normal life. Objective To assess the efficacy and safety of botulinum toxin type A (BTXA) in preventing postoperative hypertrophic scars or keloids. Methods A systematic review was performed by searching the PubMed, Cochrane Library, and EMBASE databases from their inception date up to February 2020 for randomized controlled trials (RCTs) evaluating the efficacy of BTXA in preventing hypertrophic scars or keloids. The primary outcome measures included the Vancouver Scar Scale (VSS) score, Visual Analog Scale (VAS) score, scar width, patient satisfaction, and adverse events. Results Twelve RCTs involving 497 cases (372 patients) were included. The meta-analysis showed significant differences in the VAS score (weighted mean difference [WMD] = 1.31, 95% CI = 1.06 to 1.55, P < .00001), VSS score (WMD = −1.02, 95% CI = −1.72 to −0.32, P = .004), scar width (WMD = −0.18, 95% CI = −0.29 to −0.08, P = .0008), and patient satisfaction (relative risk = 1.25, 95% CI = 1.06-1.49, P = .01). Four studies reported trivial adverse events. Conclusions This meta-analysis showed that BTXA was more effective than the control treatment in preventing postoperative scars and improving the cosmetic appearance of facial scars for East Asians, and no serious adverse events were found during the follow-up period. However, there was insufficient evidence to support the use of BTXA for the prevention of scars in patients from other ethnic groups and regions or scars in non-facial areas.

Is PRP Effective in Reducing the Scar Width of Primary Cleft Lip Repair? A Randomized Controlled Clinical Study

Objective: To evaluate and analyze the effect of platelet-rich plasma (PRP) injection on the scar formed after unilateral complete cleft lip scar repair using a modified Millard technique. Hypothesis: An unavoidable cheiloplasty scar is a result of the wound healing process that not only influences patient self-esteem for life but also affects muscle function. Design: Blind, randomized, controlled clinical trial. Patients: From December 2016 to February 2018, 24 patients with unilateral complete cleft lip undergoing primary cheiloplasties were equally assigned to study and control groups. Intervention: All patients were treated by modified Millard cheiloplasty. In the study group, PRP was injected into the muscle and skin layers immediately after wound closure, while the control group patients were treated with no PRP injection. Outcomes Measures: Scar width was assessed after 6 months through the muscle using ultrasonography and at the skin surface via photographs. Results: Scar width showed a significant improvement in the study group. Conclusions: Injection of autologous PRP provides effective improvement of cutaneous and muscular wound healing and decreases scar tissue formation.

Pulmonary vein encirclement using an Ablation Index-guided point-by-point workflow: cardiovascular magnetic resonance assessment of left atrial scar formation

Aims A point-by-point workflow for pulmonary vein isolation (PVI) targeting pre-defined Ablation Index values (a composite of contact force, time, and power) and minimizing interlesion distance may optimize the creation of contiguous ablation lesions whilst minimizing scar formation. We aimed to compare ablation scar formation in patients undergoing PVI using this workflow to patients undergoing a continuous catheter drag workflow. Methods and results Post-ablation cardiovascular magnetic resonance imaging was performed in patients undergoing 1st-time PVI using a parameter-guided point-by-point workflow (n = 26). Total left atrial scar burden and the width and continuity of the pulmonary vein encirclement were determined on analysis of atrial late gadolinium enhancement sequences. Comparison was made with a cohort of patients (n = 20) undergoing PVI using continuous drag lesions. Mean post-ablation scar burden and scar width were significantly lower in the point-by-point group than in the control group (6.6 ± 6.8% vs. 9.6 ± 5.0%, P = 0.03 and 7.9 ± 3.6 mm vs. 10.7 ± 2.3 mm, P = 0.003). More complete bilateral pulmonary vein encirclements were seen in the point-by-point group (P = 0.038). All patients achieved acute PVI. Conclusion Pulmonary vein isolation using a point-by-point workflow is feasible and results in a lower scar burden and scar width with more complete pulmonary vein encirclements than a conventional drag lesion approach.

Tribological and Thermophysical Properties of Environmentally-Friendly Lubricants Based on Trimethylolpropane Trioleate with Hexagonal Boron Nitride Nanoparticles as an Additive

Dispersions based on hexagonal boron nitride, h-BN, nanoparticles, at 0.50, 0.75 and 1.0 wt.% mass concentrations, in an ester base oil composed mainly of trimethylolpropane trioleate, were investigated as potential nanolubricants. The stability of the dispersions was assessed to determine the reliability of the tribological, thermophysical and rheological measurements. Density and viscosity were measured from 278.15 to 373.15 K, while rheological behavior was analyzed at shear rates from 1 to 1000 s−1 at 283.15 K. Newtonian behavior was exhibited by all nanolubricants at the explored conditions, with the exception of the highest concentration at the lowest shear rates, where possible non-Newtonian behavior was observed. Tribological tests were performed under a normal load of 2.5 N. Wear was evaluated by means of a 3D profiler, scanning electron microscopy and confocal Raman microscopy. The best tribological performance was achieved by the 0.75 wt.% nanolubricant, with reductions of 25% in the friction coefficient, 9% in the scar width, 14% in the scar depth, and 22% of the transversal area, all with respect to the neat oil. It was observed that physical protective tribofilms are created between rubbing surfaces.

Tribological performances of graphite–MoS2 coating at various high temperatures

The tribological performances of the graphite–MoS2 coating deposited on the disc specimen, whose material is GCr15 steel, are experimentally investigated under high temperatures. Effects of graphite content, applied load, rotational speed and test temperature on the coefficient of friction and wear scar width of the coating are evaluated. The graphite–MoS2 coating with 20 wt% graphite addition exhibits the relatively small coefficient of friction and wear scar width at 200 ℃. At or beyond 400 ℃, the coating's lubricating effect is severely deteriorated with the testing time. At 200 ℃, there exists a critical applied load of 10 N and a critical rotational speed of 1250 rpm beyond which the MoS2 coating with 20 wt% graphite content is worn through and brings out a large coefficient of friction. The test results indicate that adding 20 wt% to 33 wt% graphite to MoS2 coating leads to an obvious reduction of the coefficient of friction and wear scar width for the coating at 200 ℃.

Comparison of Aesthetic Quality of the Final Scar in Abdominoplasty with Conventional and Mini Inverted t-Scar

Background and objectives: Abdominoplasty is one of the most commonly performed cosmetic procedures. The excess skin in the conventional abdominoplasty is transversely excised and a single horizontal scar is formed. The mini inverted t-scar abdominoplasty is a modification of the “Fleur-de-lis” technique and involves the use of a small vertical incision in comparison to the long vertical incision. The aim of this technique is to lower the position of the final abdominal scar instead of addressing the horizontal laxity. In this study, we have compared the aesthetic satisfaction, width and the position of the scar with conventional abdominoplasty and mini inverted t-scar abdominoplasty. Materials and Methods: Thirty patients undergoing abdominoplasty and breast reconstruction with transverse rectus abdominis flap (TRAM) and deep inferior epigastric flap (DIEP) were included in the study. In 15 patients, abdominal closure with the conventional transverse scar was performed. In the remaining 15 patients, closure with a mini inverted t-scar was performed. Scar width, scar height and satisfaction scores were evaluated in both groups. Results: Scar widths, scar heights and patients’ and as well as surgeons’ satisfaction scores were better in the mini inverted t-scar group than the conventional group. Conclusions: The visibility of the vertical scar alone should not be a reason to avoid mini inverse t-scar abdominoplasty. Mini inverted t-scar can be an option to achieve a better hidden high-quality scar.