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Background: Hypertrophic scars, resulting from alterations in the normal processes of cutaneous wound healing, are characterized by proliferation of dermal tissue with excessive deposition of fibroblast-derived extracellular matrix proteins, especially collagen, over long periods, and by persistent inflammation and fibrosis. The present study aim to compare the efficacy of silicone gel versus combination of a 577-nm pro- yellow laser and silicone gel in the treatment of post-surgery hypertrophic scar. Methods: This study is a randomized comparative study In the period from 14 January 2021 up to the end of January 2023. 30 patients with post-surgery hypertrophic scar divided into two groups: A: one half of scar was managed with 577 nm diode laser 3 sessions monthly combined with application of silicone gel at home. A + B: the entire scar was treated with silicone gel within six months who admitted to the Laser unit of the Dermatology and Andrology Department at Al-Azhar University Hospital, Assiut during the study period. Results: Significant improvement in pigmentation, pliability, height and total Vancouver score. By comparing between silicone gel and combination of silicone gel and a 577 nm diode laser, the combination shows significant improving than silicone gel alone. The scar in the lip and breast area showed a significant higher improvement rate with yellow laser plus silicone gel compared to the other site. Conclusion: Combination of silicone gel and yellow laser has significant effect in making surgical scars less distinct. [ABSTRACT FROM AUTHOR]

Utilization of lasers and energy-based devices for surgical scar minimization has been substantially evaluated in placebo-controlled trials. The aim of this study was to compare reported measures of efficacy of lasers and energy-based devices in clinical trials in preventing surgical scar formation in a systematic review and network meta-analyses. Five electronic databases, PubMed, Scopus, Embase, ClinicalTrials.gov, and the Cochrane Library, were searched to retrieve relevant articles. The search was limited to randomized controlled trials that reported on clinical outcomes of surgical scars with treatment initiation no later than 6 months after surgery and a follow-up period of at least 3 months. A total of 18 randomized controlled trials involving 482 participants and 671 postsurgical wounds were included in the network meta-analyses. The results showed that the most efficacious treatments were achieved using low-level laser therapy) (weighted mean difference -3.78; 95% confidence interval (95% CI) -6.32, -1.24) and pulsed dye laser (weighted mean difference -2.46; 95% CI -4.53, -0.38). Nevertheless, low-level laser therapy and pulsed dye laser demonstrated comparable outcomes in surgical scar minimization (weighted mean difference -1.32, 95% CI -3.53, 0.89). The findings of this network meta-analyses suggest that low-level laser therapy and pulsed dye laser are both effective treatments for minimization of scar formation following primary closure of surgical wounds with comparable treatment outcomes. [ABSTRACT FROM AUTHOR]

Abdominal wall endometriosis is atypical localization of the extra-pelvic endometriosis with non-specific symptoms and is difficult for diagnosis. Cesarean scar endometriosis (CSE) is the most common type of abdominal wall endometriosis, which usually develops after obstetric operations. We report a case of a 33-year-old woman who had two previous cesarean sections presented with a mass in the subcutaneous tissue of the abdominal wall, approximately 4 cm superior to the Pfannenstiel incision, 5 years after her second lower segment caesarean section. The classic clinical presentation, imaging findings on ultrasonography and computed tomography are analyzed. Treatment with local surgical excision of the mass is discussed. The diagnosis was confirmed with histopathological analysis of the surgical sample. When it comes to the limited painful lesion in the subcutaneous tissue at the cesarean scar, with a pain intensifying during menstruation, the physician should consider cesarean scar endometriosis in women of reproductive age with a history of cesarean section. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the outcomes of the nasolabial flap in the management of oral submucous fibrosis (OSMF). The descriptive case series included 75 patients diagnosed with OSMF who underwent surgical intervention under general anesthesia. Preoperative mouth opening measurements were compared with postoperative measurements taken after 2 months. Regarding mouth opening, out of the 75 patients, 4 (5.3%) had unsatisfactory results after treatment, while 22 (29.3%) experienced satisfactory outcomes. The majority of patients, 49 (65.3%), achieved normal mouth opening (more than 30 mm) following the Nasolabial flap procedure. This indicates that the Nasolabial flap yielded favorable results in terms of restoring normal mouth opening and benefiting the patients. Based on the findings of this study, the Nasolabial flap was determined to be a viable surgical option for managing oral submucous fibrosis due to its ease of operation, reliable flap vascularity, and low post-operative complication rate. The only drawback identified was the presence of a surgical scar, which can be addressed through secondary correction procedures. [ABSTRACT FROM AUTHOR]

Alaa Abd-Elsayed,1 Jason Pope,2 Derick A Mundey,3 Konstantin V Slavin,4,5 Steven Falowski,6 Ahish Chitneni,7 Stephen R Popielarski,8 Jarod John,9 Samuel Grodofsky,10 Tony Vanetesse,11 Michael A Fishman,11 Philip Kim11 1Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; 2Evolve Restorative Center, Santa Rosa, CA, USA; 3United Anesthesia Services, P.C., Plymouth Meeting, PA, USA; 4Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA; 5Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA; 6Neurosurgical Associates of Lancaster, Lancaster, PA, USA; 7Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital - Columbia and Cornell, New York, NY, USA; 8Thermaquil, Inc., Philadelphia, PA, USA; 9Argires Marotti Neurosurgical Associates, Lancaster, PA, USA; 10Philadelphia Smart Pain & Wellness, Bala Cynwyd, PA, USA; 11Center for Interventional Pain Spine, LLC., Wilmington, DE, USACorrespondence: Alaa Abd-Elsayed, FASA Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA, Tel +1 608-263-8100, Fax +1 608-263-0575, Email alaaawny@hotmail.comAbstract: Painful scars can develop after surgery or trauma, with symptoms ranging from a minor itch to intractable allodynia. The problem of the painful scar may involve both intraneural and extraneural structures, requiring a systematic approach to diagnosis and treatment of this neuropathic pain condition that can impact quality of life and function profoundly. In this review, we outline the algorithm for the diagnosis, management, medical and surgical treatment of painful scars.Keywords: painful scar, surgical scar, chronic pain, scar pain, thermal nerve block

Objective: The clinical evaluation and management of an adult with head and neck rhabdomyosarcoma is explored to delineate the diagnostic challenge posed by soft-tissue sarcomas bordering scar tissue. Case Report: A 59 year old female presents with persistent, evolving paresthesia and burning in the right posterior neck, which was found to be in close proximity to a well-healed rhytidectomy scar. Serial biopsies were non-diagnostic. Six months after initial presentation, rhabdomyosarcoma was diagnosed subsequent to histopathological and immunohistochemistry analysis. A wide local excision with posterolateral neck dissection was performed. Conclusion: A high index of suspicion for soft-tissue sarcoma should be maintained for patients with persistent soft-tissue lesions, especially in areas of scarred tissue, who present with new-onset neurological symptoms in the context of nondiagnostic biopsies. [ABSTRACT FROM AUTHOR]

Objectives: This retrospective study evaluates the effectiveness of pulsed dye laser (PDL) treatment in early versus late treatment groups for traumatic or postoperative scars. The study aims to determine the threshold between early and late treatment. Additionally, it investigates factors that may influence wound healing outcomes., Methods: The medical records of 147 patients who underwent PDL treatment at our institution between January 2018 and December 2022 were retrospectively reviewed. Inclusion criteria were patients receiving PDL treatment for traumatic or postoperative scars. Out of these patients, we selected those who were willing to receive telephone interviews or re-visit at a scheduled time. Eventually, 52 participants were included in our study. A standardized questionnaire was administered to all participants during telephone interviews, encompassing inquiries regarding their medical history, treatment experiences, and the patient component of the Patient and Observer Scar Assessment Scale. Among the enrolled patients, 38 were contacted and interviewed via telephone, while the remaining 14 patients attended follow-up visits where photographs of their current skin condition were captured. The pretreatment and latest follow-up photographs obtained from the clinical database were independently scored in a blinded manner by two dermatologist reviewers using both the Vancouver Scar Scale and the Manchester Scar Scale., Results: Among the 52 patients, 43 (82.7%) were successfully treated with good response. The correlation coefficients between week-to-treatment initiation and posttreatment MSS and VSS among patients with good response were 0.50 (p < 0.001) and 0.46 (p = 0.002), respectively. Given these findings, we established a treatment initiation threshold of 10 weeks, distinguishing patients into early and late treatment groups. The early treatment group showed borderline significantly lower posttreatment MSS and VSS scores than the late treatment group (MSS: 7.5 ± 2.1 vs. 9.3 ± 2.5, p = 0.011; VSS: 2.8 ± 2.0 vs. 4.5 ± 2.3, p = 0.011). Furthermore, both MSS and VSS of posttreatment showed significantly greater improvement in the early treatment group (4.4 ± 1.6 vs. 3.2 ± 1.9; p = 0.03 and 3.8 ± 1.8 vs. 2.8 ± 1.4; p = 0.04)., Conclusions: Early intervention using a PDL within 10 weeks post-injury achieved better outcomes in treating traumatic and postoperative scars based on both clinical and patient opinions., (© 2024 Wiley Periodicals LLC.)

Background: Scar severity and scar viewing are known to affect body image. The literature is lacking on the relationship between body image and surgical scar assessment. The aims of this study were to compare patients from 3 different surgical departments in terms of body image and scar assessment at discharge, in comparison with nurses' scar assessment, and 3 months post‐surgery. In addition, the research examined age and gender in relation to the main variables. Methods: A longitudinal, comparative, correlational study was conducted using an instrument which included a health history, a nurses scar assessment tool and a patient scar assessment tool at hospital discharge, as well as a body image tool used both at discharge and at 3 months' post‐surgery. The 10‐item body image scale was comprised of affective items, behavioural items and cognitive items. The STROCSS 2019 checklist is used. Results: 75 patients were studied who were mostly male (68.0%) with a mean age of 59 and married (77.3%). The sample distribution of departments included 30.7% cardiothoracic, 29.3% neurosurgery and 40% urology. Cardiothoracic patients displayed a significant negative body image pre‐surgery compared to post‐surgery. Neurosurgical patients' scar assessments were significantly higher than nurses' assessments with no differences found in the other departments. Conclusions: The healthcare team needs to consider engaging patients in post‐surgery discussions concerning scarring and body image. The results of this study revealed that expectations in both clinician and patient participants need to be assessed and evaluated for congruency in order to offer a greater patient‐focused peri‐operative experience. [ABSTRACT FROM AUTHOR]

Objective: When using laser therapy to effectively treat scars, the choice of treatment parameters depends on the knowledge accuracy of the underlying scar pathology, which is often difficult to judge by gross physical exam. As such, more quantitative measures are needed. In recent years, optical coherencetomography (OCT) has shown promise as a real-time imaging technolgoy of skin microstructure. A key step in developing a methodology for utilizing OCT to develop a comprehensive 'atlas' of OCT characteristics of a wide variety of scar types. This atlas may then be used as a tool for selecting the optimal treatment modality and parameters for each scar type.Methods: One hundred and fifty scars of a wide range of anatomical locations were imaged using OCT, capturing both vascular and structural data. A variety of scar etiologies (e.g. burn, surgical, traumatic) and types (e.g. hypertrophic, keloidal, atrophic) were included. Comparator scans were also taken from normal, unscarred skin.Results: OCT revealed morphological differences in the epidermis and dermis between scars and normal tissue, and between scar subtypes. Features affected by scar pathology included epidermal thickness, skin surface texture, dermal epidermal junction rugosity, blood vessel density, vessel shape and diameter, vessel direction and vascular network, dermis scattering intensity and non-uniformity. Each scar subtype showed consistent characteristics distinct from other scar subtypes.Limitations: This was a single-site study of a patient population in South Florida.Conclusion: OCT is a powerful new objective tool for the clinician to utilize in the pursuit of effective laser treatment parameters by enabling personalized treatment based on individual scar characteristics in order to maximize treatment capabilities. [ABSTRACT FROM AUTHOR]

Infiltration of pre-existing scars by sarcoidal granulomas is uncommon. The pathogenesis remains bizzare and the significance of this rather peculiar symptom remains neglected. Incidence of sarcoid specific cutaneous lesion with or without systemic involvement is 1.9/1 lakh population with female preponderance. The case of a 48year old female with complaints of fever, myalgia and a painful surgical scar with a past history of open cholecystectomy two decades back is reported. Tissue biopsy after scar revision surgery revealed abundant non-caseating granulomas with asteroid bodies establishing a diagnosis of cutaneous sarcoidosis with an unremarkable systemic examination. Triamcinalone infiltration of the revised scar was performed with a consideration of short course of steroids at the earliest sign of inflammation/systemic involvement. In the absence of systemic involvement, isolated cutaneous sarcoidosis could be an early sign of systemic progression which requires close monitoring and follow up. [ABSTRACT FROM AUTHOR]

Surgical management of grade III gynecomastia with excess redundant skin is challenging. The choice of the surgical technique is mainly decided upon the size of the gynecomastia, the skin redundancy and correction of nipple position. We report our experience in the use of the circular incision bi-pedicled vertical flap based mastectomy for grade III gynecomastia according to Simon classification. This is a retrospective study conducted between January 2022 and April 2023 at two selected units in Sri Lanka. A total of 7 patients with bilateral grade III gynecomastia were included in this study with a median age of 24 years (range: 18–42 years). The mean BMI was 23.2 kg/m 2 . All patients exhibited near symmetrical breasts and large areolar diameters. All patients complained of physical and psychological dissatisfaction with their condition and sought an aesthetic correction. Two patients were diagnosed with Klinefelter syndrome and others were apparently healthy. The main complication was seroma formation (7/7). No patients developed haematoma. Nipple hypothesia was noted in two patients which improved on follow up. The mean follow- up duration was 4–9 months. The survey of patient satisfaction showed 9 for contour, 8.6 for wound scars, 9.2 for overall satisfaction and 9.6 for improvement in self-confidence. The above surgical technique achieved satisfactory aesthetic results while avoiding unsightly scars or serious complications and can be considered in the surgical decision making for grade III gynecomastia. • Surgical management of grade 3 gynecomastia is challenging. • This article describes the experience in the use of the circular incision bi-pedicled vertical flap based mastectomy for grade 111 gynecomastia. • This surgical technique achieves satisfactory aesthetic results while avoiding unsightly scars. [ABSTRACT FROM AUTHOR]

Background: The long-term effects of childhood surgery scars on health status, quality of life (QoL), self-esteem, and body image remain uncertain. This study explores these effects in school-aged children., Methods: We conducted a retrospective cohort study involving 454 children (58% boys; 8-17 years) who had undergone surgical correction of anatomical anomalies or neonatal ECMO. Data included patient-reported scar perception and scar-related embarrassment, along with psychological assessment via questionnaires., Results: About 34% of children rated their scars as 'nice-looking', 49% as 'indifferent', and 12% as 'rather ugly'. Most children (91%) never experienced scar-related embarrassment, while frequent embarrassment was reported by 3%. Surgical scar correction was desired by 6% of the 8-year-olds and 19% of the 17-year-olds. Scar perception did not significantly affect health status or QoL. However, negative scar perception was associated with lower self-esteem in girls and a more negative body image in boys. Girls were more likely to report negative scar perception (OR: 1.54, 95%-CI: 1.06-2.24) and scar-related embarrassment (OR: 4.29, 95%-CI: 1.77-10.44)., Conclusion: Children who underwent surgery in the neonatal period and subsequently grew up with scars resulting thereof, mostly perceive them either indifferently or positively, with minimal effect on health status and QoL. Nonetheless, some children, particularly girls, experienced negative perceptions of their scars, although scar-related embarrassment was rare. We recommend integrating scar assessment into routine follow-up at ages 12 and 17, and offering appropriate and timely guidance and support to children at risk for negative effects of scars., Level of Evidence: III., Competing Interests: Conflicts of interest The authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Scar formation is a consequence of wound healing that developed from damaged tissue either from physical injury or surgical incision. A hypertrophic scar develops due to an abnormal healing response to trauma. It might lead to serious functional and cosmetic disability. There are numerous methods mentioned in the literature to treat such scars but to date, no single method has been known to cure them. In this review, we focused on differences between various types of nonsurgical management of hypertrophic scar focusing on the indication, mechanism of action, and efficacy of the pulsed dye laser (PDL), fractional carbon dioxide laser (fCO2), Er‐YAG laser, and intense pulse light (IPL). The literature research included peer‐reviewed articles (clinical trials or scientific reviews) which were identified by searching electronic databases like PubMed till January 2021 and reference lists of respective articles. Only articles published in the English language were included. [ABSTRACT FROM AUTHOR]

Heterotopic ossification (HO) develops when bone formation appears in soft tissues, usually after an injury or major surgery. Timely and accurately diagnosing of this rare event is essential due to the possibility of misdiagnosis as a maintained foreign body, infection, incisional neoplastic recurrence, and metastatic or primary neoplasms. In this study, we present a 57-year-old man who was operated for peritonitis due to perforated appendicitis, and an asymptomatic HO was accidentally found on an incisional line of previous open prostatectomy about 5 years earlier due to benign prostatic hyperplasia. A bone density lesion was seen in the fascia and on the incisional scar of previous surgery. HO rarely occurs within an abdominal incision due to surgery. It is reported only within vertical midline incisions and mainly within the first year after the operation. Imaging confirms the diagnosis of HO in previous abdominal surgery scars, which reveals dense vertical calcification along the previous incisional scar. In the case of HO, the exclusive effective management is the entire surgical excision with primary closure, and NSAIDs are the preventive choices. HO should be considered in patients presenting with discomfort or palpable mass or even asymptomatic patients with previous abdominal surgeries besides considering relative history such as surgical complications or neoplasms. • Heterotopic ossification (HO) may be accidentally found on the incisional scar of previous abdominal surgery in asymptomatic patients. • Computed Tomography (CT) scan is useful in distinguishing HO from other similar surgical complications such as infection and maintained foreign body, intra-incisional mass, and metastatic or primary neoplasms with considering the patient's history, and is useful in deciding on surgical management. • The main HO management is the entire surgical excision with primary closure. • For prevention of HO post abdominal midline incision surgeries or recurrence after primary excisional management of previous HO, non-steroidal anti-inflammatories or external radiotherapy, can be considered. [ABSTRACT FROM AUTHOR]

Healing after dermal injury is a complex but imperfect process that results in a wide range of visible scars. The degree of disfigurement is not the sole determinant of a scar's effect on patient well-being, with a number of other factors being critical to outcome. These include cosmetic appearance, symptoms such as itch and pain, functional loss, psychological or social problems, and quality of life. An accurate assessment of these domains can help clinicians measure outcomes, develop, and evaluate treatment strategies. A PubMed literature search was performed up to 31st March 2020. Ten objective scar measurements, four Clinician-Reported Outcome Measures (CROMs), six Patient-Reported Outcome Measures (PROMs), and one combined measure were evaluated for their reliability, clinical relevance, responsiveness to clinical change, and feasibility. Many quantitative tools were limited in their clinical relevance and feasibility, whereas few qualitative CROMs and PROMs have undergone rigorous assessment. This review examines currently available assessment tools, focusing primarily on subjective scar measurements (CROMs, PROMs), and offers a perspective on future directions in the field.

Abdominal wall endometriosis refers to the presence of endometrial tissue within surgical scars, most commonly occurring following gynecological procedures such as cesarean sections. This case report presents a rare case of abdominal wall endometriosis in a cesarean scar. The patient, a 32-year-old woman with a history of two previous cesarean sections, presented with cyclic pain and swelling in the lower abdominal region. Physical examination revealed a tender, well-defined mass within the cesarean scar. Surgical excision of the mass was performed, and histopathological examination confirmed the presence of endometrial tissue. This case highlights the importance of considering abdominal wall endometriosis in the differential diagnosis of patients presenting with cyclic pain or swelling in previous surgical scars. Prompt diagnosis and appropriate management can help alleviate symptoms and prevent complications., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Surgical scars are a significant cosmetic problem, especially when in exposed areas such as the anterior neck. To avoid or reduce visible scarring, diverse innovative surgical approaches to the neck have been introduced. The purpose of this study was to evaluate the feasibility and safety of the endoscopic resection using the retroauricular approach for submandibular gland excision.Methods: The present study enrolled 48 patients who underwent conventional transcervical submandibular gland excision and 23 patients who underwent endoscope-assisted retroauricular approach submandibular gland excision, from February 2014 through February 2018 at the Department of Head and Neck Surgery and Otorhinolaryngology of the AC Camargo Cancer Center, in Sao Paulo, Brazil. The surgical outcomes were retrospectively reviewed.Results: In the conventional group, 26 (54%) patients were male. The mean age was 49.3 years (range 22-81). Twenty-two patients (46%) had sialoadenitis; twenty-one (44%) had benign and five (10%) had malignant tumors. The mean total surgical time was 86.4 min (range 40-180), and the mean total length of hospital stay was 1.3 days. Twenty-seven (56%) patients suffered from local postoperative complications in the neck. In the retroauricular group, 14 (61%) patients were male. The mean age was 44.1 years (range 24-71 years). Seven patients (31%) had sialoadenitis, twelve (53%) had benign tumors and four (16%) had malignant tumors. The mean total surgical time was 86.4 min (range 75-300 min), and the mean total length of hospital stay was 1.2 days. Twelve (53%) patients suffered from local postoperative complications in the neck. No surgical site infections or systemic complications were described.Conclusions: The retroauricular endoscopic-assisted submandibular gland resection is feasible, with excellent cosmetic results and no significant complication rate increase, and can be a safe potential surgical alternative for patients who are motivated to avoid a visible neck scar. [ABSTRACT FROM AUTHOR]

The findings regarding the association between body mass index (BMI) and sexuality outcomes are mixed. Subjective body image has been found to be more salient in predicting sexual function than actual body size. Previous studies have demonstrated appearance anxiety to be particularly significant. To evaluate the association between appearance anxiety and female sexual functions. Specific aims included the evaluation of body morphologic measurements with indicators other than BMI and determining the predictive role of surgical scars for appearance anxiety and female sexual function. Sexually active women who had been in a stable heterosexual relationship for ≥6 months participated in this study. Demographic features, anthropometric measurements including BMI, skin-fold thickness (SFT) measurements from 3 regions of the body (triceps, scapula, and abdomen) and waist circumference (WC) were assessed. Finally, participants were asked to complete the Appearance Anxiety Inventory, Female Sexual Function Index, and Beck Depression Inventory. Multivariate path analyses and hierarchical multiple regression analyses were performed. The correlations of age, BMI, presence of surgical scars, and measurements of BMI, WC, and SFT as independent variables with Beck Depression Inventory, Appearance Anxiety Inventory, and Female Sexual Function Index scores were the main outcomes of the study. The data of 329 women were analyzed. The median age of the participants was 33 (19–52) years. The mean BMI was 24.5 (SD 3.5) kg/m2. The prevalence of female sexual dysfunction was 22.8%. Multivariate analyses revealed that increased appearance anxiety (−0.45), presence of surgical scars (−0.28), accompanying depression (−0.15), SFT abdomen measurement (−0.16), and age (−0.13) were significantly associated with sexual function. Appearance anxiety was found to be associated with accompanying depression (0.56), presence of surgical scar (0.38), and measurements of the WC (0.22), BMI (0.14), SFT-abdomen (0.12), and SFT-triceps (−0.31). Clinicians should take the strong relationship between appearance anxiety and female sexual function into consideration. Body morphologic evaluation should not be limited to BMI; surgical scars and WC and SFT measurements may play a considerable role. A major limitation of this study was the lack of personal distress evaluation in the participants. Sexual complaints in middle-aged women revealed the strongest correlation with appearance anxiety. Further longitudinal studies are needed to reveal its underlying factors and implications for sexuality. Cihan A, Cihan E. Interrelation Between Appearance Anxiety and Sexual Functions in Women: The Role of Surgical Scars, Morphologic Features, and Accompanying Depression. J Sex Med 2019;16:1769–1778. [ABSTRACT FROM AUTHOR]

• Photodynamic therapy becomes a possible therapeutic approach for pathological scar. • Low tissue penetration of 5-aminolevulinic acid restricts its therapeutic efficacy. • Incomplete epithelialization at early stage of scarring provide better penetration. • Early intervention of photodynamic therapy is potential strategy for scar prevention. Surgical scar formation afflicts patients and current treatments are limited by inconsistent efficacy, long-term and painful treatment processes. In this report, a patient received 5-aminolevulinic acid-mediated photodynamic therapy (5-ALA PDT) on the first postoperative day, once a week for 5 sessions. At two-year follow-up, the intervention of 5-ALA PDT at early stage decreased the vascular density and improved extracellular matrix (ECM) deposition. The early intervention of surgical scar by 5-ALA PDT overcomes the penetration limits of photosensitizer and red light, making it a potential strategy for surgical scar prevention. [ABSTRACT FROM AUTHOR]

Jennifer Murdock,1,* Mohamed S Sayed,1,* Mehdi Tavakoli,1,2 Dimitra M Portaliou,1 Wendy W Lee1 1Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA; 2Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran *These authors contributed equally to this work Purpose: To evaluate the efficacy and safety of a topical product containing a mixture of growth factors and cytokines on the incision scar following upper eyelid blepharoplasty. Methods: This is a prospective, single-blinded, and split-face study on patients who underwent bilateral upper eyelid blepharoplasty. Two weeks after surgery, one eye of each subject was randomized to receive Lumière Bio-Restorative Eye Cream on one eyelid incision for 12 weeks and no treatment on the other eyelid. Subjects returned at the postoperative weeks 6, 10, and 14. At each visit, patients and the investigator (who was blinded to the treated eyelid) evaluated the scar through specified questionnaires. Results: A total of 20 subjects with a mean age of 66.3±9.2 years completed the study. Minor side effects were noted in three subjects. At all-time points, all subjects thought eyelids treated with Lumière had a better scar and overall appearance than fellow eyelids (P

Endometriosis is the presence of ectopic functioning endometrial tissue outside the uterine cavity. Scar endometriosis is a rare condition that typically follows obstetrical and gynecological surgeries. Although the symptoms are non-specific and varying, scar endometriosis classically presents with cyclic pain at the site of incision during menstruation. The diagnosis of scar endometriosis remains challenging and requires a comprehensive approach, including clinical presentation and histological and radiological findings. Here, we present a case of extragonadal endometriosis at the cesarean section scar. The patient presented with cyclical menstrual pain at the surgical incision. Our aim in this case report is to present the approach to diagnosing such a condition with the associated presentation and histological findings., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Al Shenawi et al.)

Background: Photobiomodulation is widely studied for its potential benefits in the wound healing process. Numerous scientific studies have highlighted its effect on various phases of wound repair, but clinical validations are few. This comparative trial aims to evaluate the influence of photobiomodulation on the post-abdominoplasty healing process.Methods: Seventeen Caucasian women (aged 18-55) who underwent an abdominoplasty were enrolled in this double-blinded, controlled clinical trial. The postoperative scars were divided into two areas; the right side of the scars was treated with ten sessions of photobiomodulation (consisting in three types of wavelengths). The other part of the scars was used as control and did not receive any additional treatment. Clinical assessments of both parts of the scars were scheduled at 1, 6 and 12 months postoperative.Results: Within six months following surgery, significantly improved quality of the scars on the treated side compared with the untreated side was reported by patients and experienced professionals according to Vancouver Scar Scale, Patient and Observer Scar Assessment Scale (p < 0.05) and standardized photographs (p < 0.05). At 1 year of follow-up, patients observed no differences between the treated and untreated sides of the scars. This suggests that photobiomodulation appears to play an early role in the wound healing process, accelerating the first stages of cicatrization.Conclusion: This study statistically validates the positive impact of photobiomodulation treatment on the first stages of the postoperative healing process. Carried out on Caucasians participants only, this study should, however, be performed on a more heterogeneous population to definitively confirm these effects on an international population.Clinical trial registry: Registro Brasileiro de ensaios clínicos: http://www.ensaiosclinicos.gov.br, Trial RBR-49PK78.Level of Evidence II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the effects of lidocaine injection to scar tissues in addition to physical therapy on pain, depression and functional status in patients diagnosed with fibromyalgia syndrome (FMS) after surgery. Methods: In this retrospective study, 45 female patients who completed their treatment out of 54 patients (52 females, 2 males) who were found to have undergone surgery prior to the diagnosis of FMS out of 117 patients (108 females, 9 males) were included. Patients were divided into groups of physical therapy (PT) and lidocaine injection to scar tissues in addition to physical therapy (PT + lidocaine). All patients underwent PT (hot pack + TENS + therapeutic ultrasound) for 15 sessions to neck / back areas. Lidocaine injection was performed 6 sessions in 3 weeks, with an average of 0.7 cc of %0.5 lidocaine to 1 cm2 scar tissue. Evaluation parameters; pain and morning stiffness [visual analogue scale (VAS)], number of sensitive points, depression level [Beck Depression Inventory (BDI)], functional evaluation [Fibromyalgia Impact Questionnaire (FIQ)]. Pre- and post-treatment data and data 4-6 weeks after treatment were recorded. Results: The study was completed with 22 of PT, 23 of PT + injection, total 45 cases. All cases were women, with a mean age of 40.69 ± 5.51 years. There was no significant difference between the groups in terms of demographic and clinical parameters before the treatment (p> 0.05). Significant improvement was found in all groups for all parameters (p <0.01).When the differences between the groups were compared, pain, morning stiffness, BDI, FIQ in PT + Lidocaine group were significantly changed compared to the PT group (p <0.01). Conclusion: Both PT and PT + lidocaine treatment are effective treatments in women with fibromyalgia syndrome (FMS). In patients who underwent PT + lidocaine, the treatment modality provided more significant well-being than the PT group in terms of pain, severity of morning stiffness, depression and functional status. [ABSTRACT FROM AUTHOR]

Background and aims. Endometriosis is a commonly encountered disorder in women of reproductive age, consisting of the presence of active ectopic endometrial tissue outside the endometrial cavity. Surgical scar endometriosis is a rare condition representing about 2% of all endometriosis cases. The purpose of this study was to assess the main characteristics, diagnostic tools and therapeutic options in abdominal wall endometriosis (AWE). Methods. We have reviewed a series of fourteen cases with histopathological confirmation of AWE that were managed in our institution. Results. The main characteristic of AWE were emphasized, showing that 78.57% of the patients had at least one previous caesarian section and that in only 57.14% of all cases an accurate diagnosis of AWE was established preoperatively. Conclusion. A direct relationship between gynecological and obstetrical surgery and AWE is well established and as the caesarian section rates increase constantly, the awareness regarding AWE should also be increased. [ABSTRACT FROM AUTHOR]

Fractional lasers have been used for the improvement of scar tissue in the recent years but there has not been extensive research on their impact. The purpose of this study was to evaluate the efficacy of nonablative fractional laser (NAFL) on acne, burn, and surgery/traumatic scar. The scars were also categorized as atrophic, hypertrophic, and keloid, and treatment efficacy was investigated accordingly. This is a retrospective, single-center study. Scar tissues were treated using a nonablative fractional 1550-nm Erbium glass laser in high-energy parameters at 4-week interval for 4-8 sessions. The scar regression score (SRS) was used to determine the decrease in scar appearance. Forty-six patients with acne (n:18), burn (n:13), or surgery/traumatic (n:15) scar were included. The number of sessions was higher for burn patients while SRS in burn patients was lower than in patients with acne or a surgical/traumatic scar. Evaluation according to scar types showed that atrophic scars had a significantly better response to NAFL treatment. This study indicates that NAFL treatment with the high-energy parameters has better outcomes in atrophic acne scars, while the success rate is considerably low in post-burn and keloid scars. [ABSTRACT FROM AUTHOR]

Background: Laser therapies are used prophylactically for excessive scar formation. The Laser-Assisted Skin Healing treatment induces a controlled heat stress that promotes tissue regeneration. This comparative trial is the first to evaluate the performance of a new automated 1210-nm laser system, compatible with all Fitzpatrick scale phototypes. Methods: Forty women undergoing bilateral breast reduction were enrolled in this double-blinded randomized controlled trial. The horizontal sutured incision of one breast was treated with the portable 1210-nm laser while in the operating theatre. The other breast was used as the study control. Objective measurements, subjective clinical assessments and safety evaluation were carried out over 1 year by both clinicians and patients. Results: Six weeks following surgery, better overall appearance and modified OSAS scores were reported for the laser-treated scars when compared to the control group ( p = 0.024 and p = 0.079). This supports an early effect of the laser treatment during the inflammatory stage of the healing process. After a post-treatment period of 6 months, there continued to be a strong tendency in favour of the laser treatment based on the subjective scores and corroborated by the objective improvement of the treated scar volume ( p = 0.038). At 1 year, the laser-treated scars continued to improve compared to the control ones in terms of volume ( p = 0.004), surface ( p = 0.017) and roughness ( p = 0.002), and these comparatively better results were strengthened with the blind expression of patients' preference for their laser-treated scar ( p = 0.025). Conclusions: This new 1210-nm laser treatment, used as a single session performed immediately after surgery, provides significant objective and subjective improvements in scar appearance. These data can be useful when preparing patients to undergo their surgical procedure. Level of Evidence I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

Background: Numbness around the surgical scar can be a source of discomfort or dissatisfaction in a proportion of patients undergoing total knee arthroplasty (TKA). Literature reports wide variation in its prevalence and the consequence of numbness on the outcome of TKA is not clear. We investigated the prevalence of numbness, along with contributing factors, and assessed its effect on the functional outcome of TKA.Methods: In total, 258 knees were included in this prospective patient-reported outcome measure case-control study. Demographic details, type and length of incision, pre-operative and 1-year post-operative Knee Society Scores were recorded and compared.Results: The prevalence of numbness at 1 year was 53%, with a female preponderance. Patients older than 70 years were less affected. Discomfort due to numbness was recorded in 8.7% of the patients, 75% of which were female. The length of the incision correlated positively with the presence of numbness. The Knee Society Scores did not correlate with the presence or area of numbness.Conclusion: Our findings indicate a high prevalence of numbness after TKA. Nevertheless, numbness does not affect the functional outcome. [ABSTRACT FROM AUTHOR]

Background Post-surgical scars (PSS) are an expected consequence of surgery. Several factors have previously been associated with PSS satisfaction including patient age and time elapsed post-operative. Little data are available regarding patient attitudes toward orthopaedic PSS. Knowledge of patient attitudes and the various associated factors may allow physicians to administer peri-operative care to mitigate the potential negative effects of PSS. Our study aims to investigate the attitudes of patients toward their PSS using quantitative scar assessment scales and to identify factors associated with PSS satisfaction. Methods We conducted a retrospective study with a follow-up. We included all patients with orthopaedic PSS on their upper or lower limbs between two and 18 weeks postoperative attending Cork University Hospital, Ireland, between February and August 2022. Patients completed an initial baseline questionnaire and then a follow-up questionnaire six months post-operative. The Patient and Observer Scar Assessment Scale (POSAS) evaluated PSS satisfaction. The European Quality of Life 5 Domain (EQ-5D), alongside several Likert scales, evaluated the patient's quality of life (QoL). Results In total, 91 patients were included. The mean POSAS score was 28.41 (95% CI, 25.85-30.97). Younger patient age (p=0.045) and decreased time passed post-operatively (p=0.002) were associated with poorer PSS satisfaction. Patients reporting their PSS appearing worse than expected were more likely to agree that their QoL had been adversely affected by it (p=0.001). Conclusion Most patients were satisfied with their orthopaedic PSS. This study identified several factors associated with poor PSS satisfaction. Our finding, which associated patient scar expectations and QoL, is novel and has not been previously examined. Accordingly, peri-operative interventions, including scar expectation management, may be implemented to mitigate scar-related QoL impact., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ho et al.)

Objective: A fractional 1064-nm picosecond laser is an efficient and safe treatment for atrophic acne scars. However, evidence of using a picosecond laser for atrophic posttraumatic and surgical scar therapy is lacking. This study aimed to evaluate the efficacy and safety of using a 1064-nm picosecond laser with a microlens array (MLA) for the treatment of atrophic posttraumatic and surgical scars., Methods: This was a prospective, intraindividual, single-blinded, randomized split-lesion-controlled trial. Twenty-five subjects with atrophic traumatic or surgical scars that existed for more than 1 year were enrolled. All atrophic scars were divided at the midline into two halves and randomly assigned to a treatment or control side. The treatment group was treated with a 1064-nm picosecond laser with an MLA handpiece (spot size: 6-8 mm, fluence: 1.0-1.2 J/cm 2 , repetition rate: 5 Hz, three passes) for 3 monthly sessions. The scar volumes were objectively measured using a three-dimensional (3D) photograph at baseline, 1 month after the first and second treatments, and 3 and 6 months after the final treatment. Subjective assessments were conducted by a blinded dermatologist and patients' self-assessment to evaluate improvements at 3 months after the final treatment., Results: The treated sides exhibited a significant volume reduction, with statistically significant improvements over the control group at 1 month after the first and second treatments and at 3 months after the final treatment (p = 0.024, 0.005, and 0.019, respectively). At 3 months after the final treatment, a blinded dermatologist correctly identified the treated side in 24 of 25 patients (96%). The patients rated the improvements as excellent (>75%) and marked (50%-75%) in 36% and 48% of patients, respectively., Conclusion: At 3 months, the 1064-nm picosecond laser with a fractionated MLA can significantly reduce the posttraumatic and postsurgical atrophic scar volume in patients with Fitzpatrick skin types III-V. Insufficient data preclude inferences regarding efficacy at 6 months., (© 2023 Wiley Periodicals LLC.)