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BMC Musculoskeletal Disorders Mar 2023The aim of this literature review was to synthesise and report current practice in evaluation and reporting of scar outcomes in hand and wrist clinical research. (Review)
Review
OBJECTIVES
The aim of this literature review was to synthesise and report current practice in evaluation and reporting of scar outcomes in hand and wrist clinical research.
METHODS
A systematic search from inception to 2022 was conducted using three electronic databases. English language randomized controlled trials and observational cohort studies reporting standardised scar outcome measures and/or scar symptoms, appearance, impairment, function, or mental health outcomes in patients with hand and wrist scars were included. Two independent reviewers determined study eligibility and performed data extraction of a priori identified scar outcome domains. Data analysis included descriptive statistics and identification of discordance in taxonomy.
RESULTS
Fifty-nine studies were included. Elective surgery cohorts were the most frequently included clinical population (n = 28; 47%) followed by burns (n = 16; 27%). Six different standardised scar outcome measures were reported by 25% of studies however only 7% of studies utilised a patient-reported measure. Scar symptoms were the most frequently reported outcome domain (81%); but taxonomy was incongruous, constructs lacked working definitions required for generalisability and outcome measurement was variable and unreported. Nineteen different measures of scar appearance and structure were reported by 30 (51%) of studies however only nine (23%) were patient-reported. Seven different hand function PROMs were reported by 25 (43%) studies. Person-centred domains including scar acceptability (12%), mental health impact (5%), and social participation (4%) were rarely reported.
CONCLUSIONS
This review highlights that evaluation and reporting of hand and wrist scar outcomes is not standardised, assessment methods and measures are under-reported and there is discordance in taxonomy. Evaluation is not person-centred, rather it is dependent on clinician assessment. Domains including scar acceptability, mental health, and social participation are rarely addressed. A stakeholder consensus derived hand and wrist scar core outcome measurement set will promote standardisation and underpin improvements in clinical research quality, transparency, and rigour.
Topics: Humans; Cicatrix; Wrist; Mental Health; Upper Extremity; Hand
PubMed: 37004025
DOI: 10.1186/s12891-023-06296-y -
Contrast Media & Molecular Imaging 2022This research aimed to explore the related factors of scar myometrial thickness and scar diverticulum formation and then predict the occurrence of uterine diverticula....
This research aimed to explore the related factors of scar myometrial thickness and scar diverticulum formation and then predict the occurrence of uterine diverticula. 140 patients with cesarean section were selected as the research objects. According to the three-dimensional (3D) vaginal ultrasound echo and the diagnostic criteria of uterine diverticulum, the research objects were divided into a diverticulum group and a control group, with 70 cases in each group. Data such as age, number of cesarean sections, endometrial thickness, uterine position, and diverticulum size was collected, and their relationship with uterine diverticulum was compared and analyzed. The results showed that there were significant differences in menstrual days, cesarean section times, and uterine position between the two groups ( < 0.05). The height (9.02 ± 2.97), width (14.02 ± 3.08), and depth (5.14 ± 1.23) of the posterior uterine diverticula in the scar diverticulum group were all greater than the anterior uterine height (6.69 ± 1.36), the width (10.69 ± 2.15), and the depth (3.86 ± 0.69), respectively. The residual myometrium thickness in posterior position of the uterus (2.98 ± 0.75) was < anterior position of uterus (3.43 ± 0.47), and the difference was statistically significant ( < 0.05). Multivariate analysis showed that the frequency of cesarean section (1 time, 2 times), uterine position, and abnormal menstruation were independent risk factors in the scar diverticulum group ( < 0.05). In conclusion, menstrual abnormalities, the number of cesarean sections (1 time or twice), and the position of the uterus are independent risk factors for the formation of uterine scar diverticula. The deeper the diverticula, the more likely to have menstrual abnormalities, the more prone to diverticulum in patients with posterior uterus, and the deeper the diverticula in patients with 2 dissections.
Topics: Humans; Pregnancy; Female; Cicatrix; Cesarean Section; Myometrium; Retrospective Studies; Diverticulum
PubMed: 36262982
DOI: 10.1155/2022/3584572 -
Journal of Ultrasound Dec 2020There is an increasing incidence of cesarean scar defect. This article will discuss and show different and variable sonographic presentations of scar niches and uterine... (Review)
Review
There is an increasing incidence of cesarean scar defect. This article will discuss and show different and variable sonographic presentations of scar niches and uterine postpartum ultrasonography with vaginal birth after cesarean section that can be confusing and many should be unaware of. This brief review aims to help practitioners to avoid confusion and be aware and acquainted with the different sonographic findings encountered in practice related to cesarean scar. It can lead to uterine rupture I labour, dehiscence in pregnancy and placenta accreta in the future pregnancy, but this is not evidence-based and not even a contraindication for pregnancy. It is neither an indication of repair for the presenting patient nor an indication to screen these patients for such complications. It is treated if associated with infertility or bleeding and not in asymptomatic ones.
Topics: Cesarean Section; Cicatrix; Female; Humans; Myometrium; Postoperative Complications; Postpartum Period; Pregnancy; Risk Factors; Ultrasonography, Interventional; Uterus; Vaginal Birth after Cesarean
PubMed: 31482293
DOI: 10.1007/s40477-019-00403-3 -
Arquivos Brasileiros de Cardiologia Oct 2021
Topics: Cicatrix; Electrocardiography; Humans; Magnetic Resonance Imaging; Myocardium
PubMed: 34709295
DOI: 10.36660/abc.20210712 -
International Wound Journal Aug 2023This study aimed to identify some risk factors for post-burn scarring in children aged 0-18 years. One hundred and eighty two participants were involved in this cohort...
This study aimed to identify some risk factors for post-burn scarring in children aged 0-18 years. One hundred and eighty two participants were involved in this cohort study. Under the age of 18 who were admitted to the Department of Burn Reconstructive Surgery with a diagnosis of upper and lower extremity burns were followed for 6 months. A total of 182 participants (62.1% male, and 37.9% female participants) enrolled in this study. Age ranged from 1 to 17 and the average age was 3.95 ± 3.35. The degree of burn and the anatomical location of the burn had a statistically significant effect on the development of hypertrophic scars. The length of the patient's hospitalisation days and the area of the burn were statistically correlated with wound healing (P = 000, P = .074). For example, the average length of hospitalisation days was 8 ± 5 days in the hypertrophic scars group of patients, and in the group with normal scars, average bed days were 6 ± 3 days (P = .000). Grade IIIb burns increased the risk of hypertrophic scar development by 4.9 times and grade IV burns increased it by 2.5 times. In addition, when the area of burns was 11% or more, the risk of hypertrophic scar development was increased by 58.8%. In the case of wound swab infection, the risk of hypertrophic scar development was 12.4% higher (B = 1.124, 95 EI = 0.55; 2.28, P = .748). Participants' age, burn area and degree of burn are statistically significant risk factors for post-burn scarring in children aged 0-18 years.
Topics: Humans; Male; Child; Female; Infant; Child, Preschool; Infant, Newborn; Adolescent; Cicatrix, Hypertrophic; Cohort Studies; Mongolia; Wound Healing; Plastic Surgery Procedures; Wound Infection
PubMed: 36756785
DOI: 10.1111/iwj.14077 -
JACC. Clinical Electrophysiology Jun 2021
Topics: Cicatrix; Humans; Tachycardia, Ventricular; Technology; Ventricular Premature Complexes
PubMed: 34167751
DOI: 10.1016/j.jacep.2020.12.016 -
Advances in Wound Care Jan 2023Hypertrophic scarring is a challenging issue for patients and clinicians. The prevalence of hypertrophic scarring can be up to 70% after burns, and patients suffer from... (Review)
Review
Hypertrophic scarring is a challenging issue for patients and clinicians. The prevalence of hypertrophic scarring can be up to 70% after burns, and patients suffer from pain, itching, and loss of joint mobility. To date, the exact mechanisms underlying hypertrophic scar formation are unclear, and clinical options remain limited. Several studies have demonstrated that pathological scars are a type of hyperactive vascular response to wounding. Scar regression has been found to be accompanied by microvessel occlusion, which causes severe hypoxia, malnutrition, and endothelial dysfunction, suggesting the essential roles of microvessels in scar regression. Therefore, interventions that target the vasculature, such as intense pulsed light, pulsed dye lasers, vascular endothelial growth factor antibodies, and Endostar, represent potential treatments. In addition, the mass of scar-associated collagen is usually not considered by current treatments. However, collagen-targeted therapies such as fractional CO laser and collagenase have shown promising outcomes in scar treatment. Traditional modalities used in current clinical practice only partially target scar-associated microvessels or collagen. As a result, the effectiveness of current treatments is limited and is too often accompanied by undesirable side effects. The formation of scars in the early stage is mainly affected by microvessels, whereas the scars in later stages are mostly composed of residual collagen. Traditional therapies do not utilize specific targets for scars at different stages. Therefore, more precise treatment strategies are needed. Scars should be classified as either "vascular-dominant" or "collagen-dominant" before selecting a treatment. In this way, strategies that are vascular-targeted, collagen-targeted, or a combination thereof could be recommended to treat scars at different stages.
Topics: Humans; Cicatrix, Hypertrophic; Vascular Endothelial Growth Factor A; Carbon Dioxide; Lasers, Dye; Collagen; Hypertrophy
PubMed: 34328823
DOI: 10.1089/wound.2020.1348 -
Ugeskrift For Laeger Mar 2022Damaging the normal skin barrier results in a cascade of reactions resulting in scar formation. Transforming growth factors cause the proliferation of fibroblasts to... (Review)
Review
Damaging the normal skin barrier results in a cascade of reactions resulting in scar formation. Transforming growth factors cause the proliferation of fibroblasts to myofibroblasts, which keep secreting collagen. There are indications, that the proliferation might be inhibited by adipose-derived stem cells (ADSC). Nanofat is a liquid substance containing ADSC. This review is based on five observational human studies, where nanofat was injected into a variant of scars. A significant improvement was demonstrated in all the studies. Scars treated within five years has a better chance of regeneration. Randomized controlled trials are warranted.
Topics: Adipocytes; Adipose Tissue; Cicatrix; Collagen; Humans; Transplantation, Autologous
PubMed: 35315762
DOI: No ID Found -
Archives of Endocrinology and Metabolism Jun 2021
Topics: Cicatrix; Humans; Parathyroid Glands; Thyroid Gland; Thyroidectomy
PubMed: 34191416
DOI: 10.20945/2359-3997000000381 -
Journal of Plastic Surgery and Hand... 2023The challenge in the operative therapy for enlargement of the male breast is to deal with the skin excess. Shape and scars are the major parameters after which patients... (Review)
Review
OBJECTIVES
The challenge in the operative therapy for enlargement of the male breast is to deal with the skin excess. Shape and scars are the major parameters after which patients assess their operative result. Therefore, we assessed the satisfaction rate among patients undergoing subcutaneous mastectomy at our institution with special regard to scar tissue formation and the postoperative appearance of the chest wall in dependence of the surgical approach (periarolar versus inframammary fold).
METHODS
The study includes = 36 male patients who underwent subcutaneous mastectomy at AGAPLESION Markus Hospital Frankfurt/Main. Patient's satisfaction dependent with the appearance of the chest wall and scar formation was evaluated by a modified BREAST Q® questionnaire plus two male-based additional questions.
RESULTS
There is no statistically significant difference in satisfaction with the operative result depending on the pattern of incision (periareolar versus submammary periareolar; 81.9% versus 75.5%) with the operative result. Evaluation of additional questions of the modified BREAST Q® questionnaire showed that 86% of the patients ( = 31) would rather have more scars and a flatter chest wall. A BMI >25 kg/m is accompanied by a higher risk for complications ( = 0.04).
CONCLUSIONS
Periareolar incision is still the method of choice, if promising an aesthetic appealing result. When reaching its limits though, we showed that a flat and male-shaped appearance of the chest wall is priority for the patients and should therefore be for the surgeon as well.
Topics: Humans; Male; Cicatrix; Gynecomastia; Breast Neoplasms; Mastectomy; Retrospective Studies; Patient Reported Outcome Measures; Patient Satisfaction; Mammaplasty
PubMed: 34591727
DOI: 10.1080/2000656X.2021.1981349