• Journal of Chest Surgery
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• v.33 no.1
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• pp.20-25
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• 2000

Background: Median sternotomy remains the standard approach used by surgeons for most intracardiac operations but the residual scar is cosmetically unsatisfactory. To avoid an unsightly midline scar we have tried to use alternative skin incision (bilateral subm-ammary skin incision) to median sternal skin incision, In this study we have tried to compare different postoperative results of wound between two different skin incisional methods. Material and Method: Between June 1997 and June 1998, a bilateral subma-mmary skin incision combined with vertical sternotomy was performed in 21 pediatric female patients (submammary group)to repair acyanotic congenital heart disease. after the period we carried out a retrograde study about postoperative wound states comparing this incision with median sternal skin incision controls in whom there were 23 pediatric pat-ients (control group). Result: Patients' age ranged from 14 to 96 months(mean 38.2 months) Mean duration of subcutaneous drains using Hemovac which was used only in the patients of submammary group was 4.2 days and total amount of the drained effusion was 51.1 ml. Postoperative wound complications included wound eruption in one patient wound disruption in one patient and skin necrosis in 3 patients in submammary group and included wound disruption in 4 patients in controls. mean duration required for wound healing was 15,5 days in submammary group versus 10.4 days in controls. The mean scar length was 12.5 cm in submammary group versus 11.3 cm in controls. The average follow-up was 8.2 months in submammary group versus 9.0 months in controls. In submammary group 3 patients parents(14.3%) were pleased with their cosmetic results of wound scar but 8(38.1%) were dissatisfied. Among the 23 patients in control group 8(34.8%) were pleased but 8(34.8%) complained ofunhappiness with the scar.

• Archives of Craniofacial Surgery
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• v.18 no.1
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• pp.9-15
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• 2017

Background: Relaxin is a transforming growth factor ${\beta}1$ antagonist. To determine the effects of relaxin on scar reduction, we investigated the scar remodeling process by injecting relaxin-expressing adenoviruses using a pig scar model. Methods: Scars with full thickness were generated on the backs of Yorkshire pigs. Scars were divided into two groups (relaxin [RLX] and Control). Adenoviruses were injected into the RLX (expressing relaxin) and Control (not expressing relaxin) groups. Changes in the surface areas, color index and pliability of scars were compared. Results: Fifty days after treatment, the surface areas of scars decreased, the color of scars was normalized, and the pliability of scars increased in RLX group. Conclusion: Relaxin-expressing adenoviruses improved the surface area, color, and pliability of scars. The mechanism of therapeutic effects on scar formation should be further investigated.

• Journal of Home Health Care Nursing
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• v.26 no.3
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• pp.341-348
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• 2019

Purpose: Severe burn injuries require long periods of hospitalization and treatment, which results in various physical and psychological issues. The main purpose of this study was to identify burn characteristics and psychological problems that influence Health Related Quality of Life (HRQoL) after discharge. Methods: A cross-sectional descriptive study using mobile/web or paper-based survey methods was conducted from a major burn center. A total of 145 patients completed the scar assessment, quality of life, sleep disorders, and depression scales. Results: The overall mean HRQoL and scar status scores were 2.28 out of 5 and 34.45 out of 60 points, respectively. Participants with higher burn degree, joint involvement, and emotional distress reported significantly lower HRQoL and scar status. Participants with depression and sleep problems also had lower HRQoL. Significant predictors of HRQoL included burn range, scar status, depression, and sleep issues. Conclusion: The results show that patients with severe burn injury experience high levels of physical and psychological problems. Patients with severe burn injury and psychological problems such as depression and sleep are likely to experience a reduced HRQoL. Psychological management and intervention in home care setting may improve HRQoL of burn patients.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.743-747
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• 2008

Purpose: Malignant changes of Marjolin's ulcer arising from chronic burn scar are rare. The majority of them are squamous cell carcinoma and basal cell carcinoma. Malignant fibrous histiocytoma is a deep seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. Methods: We report a 58-year-old male patient who was admitted due to $3.5{\times}5cm$ chronic ulceration of anterior chest wall on the center of old burn scar. His scar had been occurred by boiling oil and treated with conservative treatment 45 years ago. Preoperative punch biopsy showed suspicious malignant changes and contrast enhanced chest CT showed well-defined, irregular shape enhancing lesion on anterior chest wall without intrathoracic metastasis. Results: The tumor was widely excised and defect was covered with skin graft without infection, necrosis and any other complication. The pathologic findings are compatible with malignant fibrous histiocytoma(storiform - pleomorphic type). The patient underwent 3 cycles of chemotheraphy. Although distant metastasis to the lung developed 6 months later and the patient died 9 month later, there was no local reoccurrence. Conclusion: Aggressive and early excision is needed because malignant fibrous histiocytoma has characteristics of high malignancy with a propensity for early and distant spread. Furthermore, the patient's education about disease entity and postoperative regular follow-up for local recurrence or metastasis is very important. To prevent malignancy from secondly healing burn scar, early skin graft is recommended for patients with deep second degree burn.

• Archives of Plastic Surgery
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• v.45 no.4
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• pp.367-374
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• 2018

Background This analysis presents patient-reported outcomes of breast augmentation procedures performed in Singapore using an inframammary fold incision and the "5 Ps" best practice principles for breast augmentation. These data are the first of their kind in Southeast Asian patients. Methods Through a retrospective chart review, patients who underwent primary breast augmentation with anatomical form-stable silicone gel breast implants using an inframammary fold incision were followed for ${\geq}6$ months postoperatively. The BREAST-Q Augmentation Module (scores standardized to 0 [worst] - 100 [best]) and Patient and Observer Scar Assessment Scale (POSAS; 1 [normal skin] to 10 [worst scar imaginable]) were administered. Responses were summarized using descriptive statistics. Patient-reported events were collected. Results Twenty-two Southeast Asian patients (mean age, 35.1 years) completed ${\geq}1$ postoperative BREAST-Q and POSAS assessment and were assessed 11 months to 5.5 years postoperatively. The mean postoperative BREAST-Q satisfaction with breasts and psychosocial well-being scores were 69.2 and 84.0, respectively. The mean POSAS score for their overall opinion of the scar was 4.2; the mean scores for all scar characteristics ranged from 1.2 to 4.2. Over 90% of patients (20/22) said that they would recommend the procedure. Patient complaints following surgery included anisomastia (possibly pre-existing; n=2), sensory loss at the nipple (n=2) or around the nipple (n=3), scarring (n=4), and slight capsular contracture (n=1). No patients required reoperation. Conclusions Southeast Asian patients reported high long-term satisfaction scores on the BREAST-Q scale and with their scar characteristics following breast augmentation using an inframammary fold incision, and nearly all said they would recommend this procedure. No reoperations were necessary in patients assessed for up to 5.5 years postoperatively.

• Archives of Plastic Surgery
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• v.42 no.5
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• pp.596-600
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• 2015

Background The uptake of breast reconstruction is ever increasing with procedures ranging from implant-based reconstructions to complex free tissue transfer. Little emphasis is placed on scarring when counseling patients yet they remain a significant source of morbidity and litigation. The aim of this study was to examine the scarring preferences of men and women in breast oncoplastic and reconstructive surgery. Methods Five hundred men and women were asked to fill out a four-page questionnaire in two large Irish centres. They were asked about their opinions on scarring post breast surgery and were also asked to rank the common scarring patterns in wide local excisions, oncoplastic procedures, breast reconstructions as well as donor sites. Results Fifty-eight percent of those surveyed did not feel scars were important post breast cancer surgery. 61% said that their partners' opinion of scars were important. The most preferred wide local excision scar was the lower lateral quadrant scar whilst the scars from the deep inferior epigastric artery perforator (DIEP) flap were most favoured. The superior gluteal artery perforator flap had the most preferred donor site while surprisingly, the DIEP had the least favourite donor site. Conclusions Scars are often overlooked when planning breast surgery yet the extent and position of the scar needs to be outlined to patients and it should play an important role in selecting a breast reconstruction option. This study highlights the need for further evaluation of patients' opinions regarding scar patterns.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.11-18
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• 2009

Purpose: Excessive scarring in the forms of keloid and hypertrophic scar could be a consquence of the accumulation of granulation tissue cells due to aberrant control of apoptosis. Verapamil retard extracelluar matrix production and inhibits VEGF production in primary cultured keloid fibroblast. The object of this study was effect of verapamil on VEGF expression and apoptosis in early wound scarring of the rabbit ear. Methods: Full thickness wounds were created on the ventral side of 6 New Zealand rabbits's ear. 16 days after initial wounding verapamil and saline were injected each scars and scars were harvested 1 week, 2 weeks, 4 weeks later. The wounds were stained with hematoxylin and eosin, TUNEL stain, immunohistochemical stain for VEGF and calculated scar elevation index. Results: Histologic analaysis demonstrated significant reduction in inflammation, vascularity and improvement in dermal collagen organization in experimental group. In TUNEL staining apotosis positive cells were increased and immunohistochemial staining of VEGF demonstrated significant reduction of VEGF expression in experimental group. No significant difference was noted in scar elevation index between two groups. Conclusion: This study suggest that intralesional injection of verapamil on early wound scarring of the rabbit ear decreased VEGF production and increased apoptosis and have a benefit on the pathophysiology of scar formation.

• Plant Biotechnology Reports
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• v.4 no.1
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• pp.1-7
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• 2010

Definitive identification of original plant species is important for standardizing herbal medicine. The herbal medicines Cynanchi Wilfordii Radix (Baekshuoh in Korean and Beishuwu in Chinese) and Polygoni Multiflori Radix (Hashuoh in Korean and Heshuwu in Chinese) are often misidentified in the Korean herbal market due to morphological similarities and similar names. Therefore, we developed a reliable molecular marker for the identification of Cynanchi Wilfordii Radix and Polygoni Multiflori Radix. We used random amplified polymorphic DNA (RAPD) analysis of three plant species, Polygoni multiflorum, Cynanchum wilfordii, and Cynanchum auriculatum, to obtain several species-specific RAPD amplicons. From nucleotide sequences of these RAPD amplicons, we developed six sequence characterized amplification region (SCAR) markers for distinguishing Polygoni Multiflori Radix and Cynanchi Wilfordii Radix. Furthermore, we established SCAR markers for the simultaneous discrimination of the three species within a single reaction by using multiplex-PCR. These SCAR markers can be used for efficient and rapid authentication of these closely related species, and will be useful for preventing the distribution of adulterants.

• Korean Journal of Medicinal Crop Science
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• v.19 no.3
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• pp.162-169
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• 2011

The rhizomes and herbal medicines originating from Acorus gramineus, A. calamus, A. tatarinowii, and A. gramineus var. pusilus, show significant similarity, and the correct identification of species is very difficult. Random Amplified Polymorphic DNA (RAPD) and Sequence Characterized Amplified Region (SCAR) were used to develop a reliable method for identification of these four species. Several distinct SCAR markers were developed from species-specific RAPD amplicons for each species. Furthermore, a useful molecular marker was established for multiplex-PCR, in order to the four species could be distinguished concurrently. These markers allow efficient and rapid identification of closely-related Acorus species and will be useful for standardization of herbal medicines.

• Archives of Craniofacial Surgery
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• v.18 no.4
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• pp.230-237
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• 2017

Background: The traditional approach for reduction of frontal sinus fractures is coronal incision. Inherent complications of the coronal approach include long scar, hair loss, and long operation time. We describe a simple approach for the reduction of frontal sinus anterior wall fractures using a suprabrow incision that is commonly used for brow lift. Methods: From March 2007 to October 2016, the authors identified patients with anterior wall frontal sinus fractures treated by open reduction through a suprabrow incision. Only cases with photographic/radiographic documentation and a minimum follow-up of 6 months were included. The incision line was designed to be at the upper margin of the eyebrow. Medical records and radiographic data were retrospectively reviewed. Surgical outcomes, cosmetic results, and complication were assessed. The patient scale of the patient and observer scar assessment scale was used to assess patient satisfaction for incisional scar at the 6-month follow-up. Results: Thirty-one patients underwent fracture reduction through a suprabrow approach during the study period, with a mean follow-up of 41 months. No patients showed any recurrent displacement, eyebrow asymmetry, or infection during follow-up. Thirteen patients reported their forehead paresthesia postoperatively, and 12 of them had preoperative symptom. One patient complained of incisional scar and underwent scar revision. All patients were satisfied with their eyebrow and forehead contour. Conclusion: The suprabrow approach allowed for an accurate reduction of the fractures in the anterior wall frontal sinus by providing direct visualization of the fracture. This transcutaneous approach can effectively restore forehead contour with acceptable postoperative complications and patient satisfaction.