The role of scar massage in cleft lip surgery

Introduction: Despite advances in surgical technique for cleft lip, minimal evidence exists for methods of scar management, particularly scar massage. Some parents express concern that lip massage creates pain and distress to their children. This study aims to determine whether scar massage has enough cosmetic advantage to justify its use. Method: We reviewed 33 unilateral complete cleft lip repairs performed at our institution. Information on repair technique, suture material and scar management were recorded. Parent questionnaires and clinical photography were used with a panel of eight trained blinded observers asked to assess photos taken 24 months postoperatively. Scars were graded using a scale of 1 (very poor) to 5 (excellent). Twenty patients were included. Ethics approval was obtained from The Royal Children’s Hospital Melbourne Research Ethics and Governance office with HREC reference number QA/60562/RCHM-2019. Results: Frequency of scar massage was not associated with a better scar score (p= 0.36). Both the technique of repair and type of suture material used had greater effect on scar grading than massage therapy. Discussion: Problematic scarring following cleft lip surgery is a challenging outcome. This is the first study aiming to explore the effect of scar massage following cleft lip surgery. Conclusion: We found no conclusive evidence to support the use of scar massage in the postoperative care of cleft lip patients. Limitations include the retrospective nature of the study, low patient numbers and heterogeneity of surgical techniques. Nevertheless, there was no correlation seen between the frequency of massage and scar quality. Lip scar massage can cause significant pain to patients and distress to their family, warranting further studies to justify its use.

A retrospective study of comparison of collagen dressing versus conventional dressing for skin graft donor site

Background: Split-skin grafting is commonly employed for covering skin defects in case of ulcers, deep burns and following trauma. It involves harvesting of the epidermis and upper 1/3rd of dermis resulting in a wound called donor site wound (DSW). These wounds pose a kind of burden to patients during the process and after the process of wound healing. These wounds tend to cause pain, are at risk of getting infected, pruritis and cosmetic inconvenience. DSW has been managed with closed or open dressings. Out of many methods, we aim to compare the efficacy of collagen dressing with that of conventional dressing in this study.Methods: A retrospective study including 30 subjects were stratified into 2 groups; group A-collagen dressing and group B- conventional dressing. Patients aged between 18 to 60 years undergoing split thickness skin grafting were included. Patients who are immunocompromised, diabetic, with underlying skin disease and infected wounds were excluded. The outcome was compared in terms of pain, pruritis and scar assessment using Vancouver scar scale.Results: In the present study there was significant difference in median pain score, pruritus and median Vancouver scar score in collagen group compared to conventional group at all the intervals. Also, the incidence of surgical site infection was lower in the collagen dressing group.Conclusions: Collagen dressing is superior compared to conventional dressing in terms of lower pain score, pruritus score and Vancouver scar score.

Comparison of the modified direct closure method and skin grafting for wounds at the anterolateral thigh flap donor site

Objective This study was performed to compare the modified direct closure method and traditional skin grafting for wounds at the anterolateral thigh (ALT) flap donor site. Methods Among 29 consecutive patients with wounds at the ALT flap donor site, 14 underwent the modified direct closure method (MDC group) and 15 underwent traditional skin grafting (SG group). The operative time, follow-up time, complications, Vancouver Scar Scale (VSS) score, and Scar Cosmesis Assessment and Rating (SCAR) score of the two groups were statistically analyzed. Results The mean follow-up times in the MDC and SG group were 16.1 and 16.7 months, respectively. Two patients showed partial skin necrosis after skin grafting, but the remaining patients’ wounds healed uneventfully. The operative time in the MDC group was an average of about 64 minutes shorter than that in the SG group. The average VSS and SCAR scores in the MDC group were 2.1 and 3.0 points lower, respectively, than those in the SG group. Conclusions Compared with traditional skin grafting, the modified direct closure method is more efficient for repair of wounds at the ALT flap donor site because of its shorter operative time, better postoperative appearance of the donor site, and higher patient satisfaction.

Syndactyly release: a comparison of skin graft versus graftless techniques in the same patient

Syndactyly release may be done by skin graft or graftless techniques. We prospectively examined bilateral syndactyly releases in the same patient at one operation. The grafted side was randomized and the contralateral side was done graftless. Fourteen patients had surgery at a mean age of 27 months (range 7–166). The mean follow-up was 52 months (range 6–111). The mean tourniquet time was 97 minutes (range 66–135) for graft and 84 minutes (55–120) for graftless. The mean finger abduction was 57° (32°–80°) for graft and 54° (38°–80°) for graftless. The mean web creep score was 1.2 (0–3) for graft and 2.1 (0–3) for graftless. The mean scar score was 1.9 (1–3) bilaterally. The mean parents’ visual analogue scale for graft cosmesis was 7.1 (5–9) and 6.2 (4.3–8) for graftless. The surgeon’s visual analogue scale for graft was 7.9 (6.4–9.5) and 6.2 (4–8.7) for graftless. The therapist’s visual analogue scale was 7.9 (6.5–10) and 6.4 (4.7–8) for graftless. Although there is a longer tourniquet time with grafting, there may be advantages in appearance and web creep. Level of evidence: II

Novel rodent model for simulation of sylvian fissure dissection and cerebrovascular bypass under subarachnoid hemorrhage conditions: technical note and timing study

OBJECTIVESylvian fissure dissection following subarachnoid hemorrhage (SAH) is a challenging but fundamental skill in microneurosurgery, and one that has become increasingly difficult to develop during residency, given the overarching management trends. The authors describe a novel rodent model for simulation of sylvian fissure dissection and cerebrovascular bypass under SAH conditions.METHODSA standardized microvascular anastomosis model comprising rat femoral arteries and veins was used for the experimental framework. In the experimental protocol, following exposure and skeletonization of the vessels, extensive, superficial (1- to 2-mm) soft-tissue debridement was conducted and followed by wound closure and delayed reexploration at intervals of 7, 14, and 28 days. Two residents dissected 1 rat each per time point (n = 6 rats), completing vessel skeletonization followed by end-to-end artery/vein anastomoses. Videos were reviewed postprocedure to assess scar score and relative difficulty of dissection by blinded raters using 4-point Likert scales.RESULTSAt all time points, vessels were markedly invested in friable scar, and exposure was subjectively assessed as a reasonable surrogate for sylvian fissure dissection under SAH conditions. Scar score and relative difficulty of dissection both indicated 14 days as the most challenging time point.CONCLUSIONSThe authors’ experimental model of femoral vessel skeletonization, circumferential superficial soft-tissue injury, and delayed reexploration provides a novel approximation of sylvian fissure dissection and cerebrovascular bypass under SAH conditions. The optimal reexploration interval appears to be 7–14 days. To the authors’ knowledge, this is the first model of SAH simulation for microsurgical training, particularly in a live animal system.

Evaluation of 50 Donor Scars Undergoing Hair Restoration Using a New Cosmetic Surgery Scar Assessment Scale

The donor area scar is of utmost importance in strip-harvest hair restoration procedure. The proper assessment of the scar is important for the subsequent sessions. This study was undertaken to evaluate the quality of scar using a new Cosmetic Surgery Scar Assessment Scale (CSSAS). The study was conducted at a private hair restoration clinic. The patients undergoing first session were included. The width of the strip ranged from 15 to 20 mm. The donor wound was closed primarily using single-layer nonabsorbable 3-0 polypropylene suture and incorporating trichophytic closure. The stitches were removed on 11th postoperative day. The scars were assessed in daylight. The patients’ scars were assessed at 12th month using a self-developed scar scale which is comprised of 10 characteristics, each subdivided into 4 points (1-4), with a minimum score of 10 and maximum of 40. The higher scores represented poor scar, whereas the low scores represented good quality scar. A total of 50 patients were included. The mean age was 27.8 years. Most of the patients (56%) aged 31 years or more. The baldness pattern varied from Norwood type III to VII. The scars were assessed using the daylight. The average scar score was 14.3 out of 40. Majority of the patients (78%) had average score which was 15 or less. The maximum scar score achieved by the patients was 23 (4%). The newly developed CSSAS is very simple. It incorporates key features including the width and mobility of scar as well.

Perbandingan Penyembuhan Luka Insisi Menggunakan Pisau Bedah dan Pisau Elektrokauter Dinilai dengan Vancouver scar score pada Operasi Luka Bersih

Skin incision is usually performed by using a scalpel. It is assumed that electrocautery knife, a more recent alternative, can increase the risk of infection, impair healing, and result in poor cosmetic scar. This study was aimed to compare the healing process of incision wounds performed by using sclapels and electrocautery knives assessed with Vancouver Scar Score (VSS) at three months after operation. This was an experimental study. Subjects were 17 male patients, aged 18-55 years old, with elective operation (categorized as clean wound operation) from March through June 2016 at Prof. Dr. R. D. Kandou Hospital Manado. Each incision was performed with a scalpel first (Group A) and continued with an electrocautery knife (Group B). After 3 months of operation, the wound scars were assessed with VSS. The Wilcoxon signed ranks test showed no significant difference between the VSS of the two groups (P > 0.05). Conclusion: There was no difference in wound healing of incised wounds performed by using scalpels and by using electrocautery knives.Keywords: VSS, electrocautery, wound healing, scarAbstrak: Insisi kulit biasanya dilakukan dengan menggunakan pisau bedah. Peralatan elektrokauter merupakan alternatif baru yang dianggap meningkatkan risiko infeksi, memperlambat penyembuhan, dengan hasil secara kosmetik yang buruk. Penelitian ini bertujuan untuk membandingkan proses penyembuhan dari luka insisi menggunakan pisau bedah dan pisau elektrokauter yang dinilai dengan Vancouver Scar Score (VSS) pada operasi dengan luka bersih. Jenis penelitian ialah eksperimental. Penelitian dilakukan selama periode Maret 2016 s/d Juni 2016 pada 17 orang pasien berjenis kelamin laki-laki, berusia 18-55 tahun yang memerlukan operasi elektif di RSUP Prof. Dr. R. D. Kandou Manado dan dikategorikan operasi dengan luka bersih. Setiap insisi selalu dilakukan terlebih dahulu dengan pisau bedah (kelompok A) dan sisanya dilakukan dengan pisau elektrokauter (kelompok B), kemudian luka dinilai dengan VSS setelah 3 bulan kemudian. Hasil uji Wilcoxon signed ranks terhadap hasil VSS saat 3 bulan setelah operasi memperlihatkan tidak terdapat perbedaan bermakna antara hasil perlakuan A dan B (P > 0,05). Simpulan: Tidak terdapat perbedaan dalam penyembuhan dari kedua bagian luka insisi yang menggunakan pisau bedah dan pisau elektrokauter pada operasi dengan luka bersih.Kata kunci: VSS, elektrokauter, penyembuhan luka, jaringan parut