Presentation and management of keloid scarring following median sternotomy: a case study

<p>Abstract</p> <p>Introduction</p> <p>Keloid scars following median sternotomy are rare and occur more frequently in pigmented skin. Different management strategies have been described with variable success. We present a case of keloid scar formation following cardiac surgery including our management and the final aesthetic result.</p> <p>Case description</p> <p>A 64 year old female of fair complexion underwent mitral valve replacement. The procedure and postoperative recovery were uncomplicated, however, during the following year, thick keloid scars formed over the incision sites. Initial non surgical measures failed to relieve pain and did not offer any tangible aesthetic benefit. Eventually surgical excision was attempted. She presented to our clinic for nine months follow up with significant improvement in pain and aesthetic result.</p> <p>Discussion and Evaluation</p> <p>Several theories have attempted to explore the pathophysiology of keloid scar formation. A number of predisposing factors have been documented however none existed in this case. A variety of invasive and non invasive approaches have been described but significant differences in success rates and methodology of investigations still precludes a standardized management protocol.</p> <p>Conclusions</p> <p>In this case study a rare presentation of keloid scar has been presented. The variety of methods used to improve pain and aesthetic result demonstrates the propensity of keloid scars to recur and the therapeutic challenges that surgeons have to face in their quest for a satisfactory patient outcome.</p

Socio-economic and cultural sources of conflict between forest villagers and forest; a case study from Black Sea Region, Turkey

Human relations with the forest ecosystem vary greatly according to biophysical, demographic and economic conditions. Understanding the mutual relationships among these conditions can enable a better understanding of their drivers. Therefore, in this study, a forest management unit and the rural population within this unit were examined and the existence of the conflict phenomenon, the mutual relations between the elements possibly causing the conflict, and the dimensions of these relations were investigated. The study found that only 12% of the forest villagers were educated at a middle-school level or higher and only 17% of this section of low-income people worked in forestry activities for additional income. It was determined that the crime awareness level of the villagers engaged in forestry activities was higher than in those who did not work in this sector (X2 = 30.78; p &lt; 0.05). Moreover, the number of people who were penalized for forest crimes increased in parallel with the need for firewood / wood in their households (X2 = 9.96; p &lt; 0.05). It was found that by raising the forest villagers’ awareness concerning their legal rights, their crime awareness level also increased. (X2 = 157.46; p &lt; 0.05). As a result, the study revealed that the income and education levels of the forest villagers had a direct effect on forest crime as the main indicator of the conflict between forest villagers and forest management. © 2020, Springer Nature B.V