An Exploration of Facial Skin Scarring, Its Impact and Contemporary Evaluation

Facial skin cancer secondary to surgical treatment may be distressing due to the malignancy itself and from the consequences of its treatment. A visible postsurgical scar is an obvious reminder of the condition. This investigation sought to broaden our understanding of facial scarring and develop a novel tool for its objective evaluation. To this end, skin cancer as the most common etiology of facial scarring was reviewed. The scar scale literature was evaluated in the context of assessing scars through a biopsychosocial lens. Finally, the development of a novel scar scale was presented. Thirty-four individuals completed 13,056 ratings using a novel scar scale – the Scar Camouflage Scale (SCS). Preliminary data demonstrated intra-rater agreement of 0.74 - 0.92 and between-rater agreement of 0.78 - 0.96. In conclusion, through rigorous methodology this investigation provides preliminary support for the establishment and use of the Scar Camouflage Scale (SCS). These results provide the empiric basis for wholistic scar evaluation

Donor-Site Morbidity Following Minimally Invasive Costal Cartilage Harvest Technique

ObjectivesAutologous costal cartilage is a promising alternative for mastoid obliteration. However, donor-site morbidities of the chest wall limit the use of this graft. To address this issue, we have developed a minimally-invasive technique of harvesting costal cartilage and report donor site morbidity associated with the procedure.MethodsDonor site morbidities were evaluated for 151 patients who underwent costal cartilage harvest, canal wall down mastoidectomy, and mastoid obliteration. Pain and cosmetic concern were evaluated via visual analogue scale (VAS). Scars were evaluated via the modified Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Postoperative complications were assessed during the follow-up period.ResultsThe mean duration of noticeable pain was 5.3 days post operation. The mean VAS score for pain was 3.0 of 10 on the first day after the operation and gradually declined. At the 6 months post operation, the mean VAS cosmetic score at the costal cartilage harvest site was 0.6 of 10. The mean VSS score was 9.5 out of 10 total, and the mean POSAS score was 23.27 out of 110 total.ConclusionThe minimally-invasive chopped costal cartilage harvest technique resulted in acceptable pain, cosmetic concern, and postoperative complications for most patients. There were no major postoperative complications. Costal cartilage is an acceptable donor for mastoid obliteration in canal wall down mastoidectomy, especially in the context of the extremely low donor site morbidity of the minimally-invasive technique presented in the study

An investigation into the efficacy of single low dose of insulin in the prevention of excessive cutaneous scarring in breast surgery

Early human fetuses have the ability to heal wounds by completely regenerating tissues, leaving no evidence of scarring. However in the adult scarring is the inevitable endpoint of the wound healing process. Sometimes these scars can be pathological in nature causing both functional and aesthetic problems to those affected. Every year millions of people around the globe acquire problematic or pathological scars either whilst undergoing surgery or from traumatic injuries and at present there remain a severely limited number of pharmacological treatment options to offer these patients. Importantly currently there exists no treatment that can either eliminate or reliably reduce acquired scars. Not only is the treatment of acquired scars problematic but also the clinical assessment of scars is largely subjective in nature and frequently relies on assessment scales that show large amounts of inter-rater variation and lack quantification. Especially subjective is the measurement of scar colour, which can be markedly different from the surrounding skin and cause significant distress to the patient. Without an objective assessment framework clinicians cannot reliably examine scars nor gauge responses to any treatment. The aim of this thesis is thus two-fold. Firstly a new anti-scarring treatment in the form of insulin will be tested in a randomised, double blind, intra-patient, placebo controlled trial where patients undergoing elective bilateral breast surgery will have low-dose insulin injected subcutaneously to one breast and placebo to the other at the time of surgery. Patients will be followed up for 12 months and their scars compared to examine the therapeutic effect of insulin upon scars. Secondly the thesis aims to test the validity of new methods of assessing the scar colour of a subset of patients within the insulin trial using previously untested photographic devices and software. These devices are hoped to add much needed quantification to scar assessment.Open Acces

The Importance of Psychometric and Physical Scales for the Evaluation of the Consequences of Scars—A Literature Review

Background: Scars affect patients after trauma, burns, or surgical procedures and can generate both physical and psychosocial changes. The aesthetic damage represents the modification of a person’s physical appearance, in its bodily integrity, causing numerous sufferings and determining social or economic consequences. The aim of this research is to evaluate the advantages and disadvantages offered by the available psychosocial and physical scar scales in assessing the physical, aesthetic, psychosocial, and juridical consequences of scars. This will aid to inform medical examiners about the most valued existing scales to allow them to select the most appropriate instrument to manage their patient. Methods: A broad search of relevant scientific studies on the psychosocial determinants of post-traumatic and surgical scars was conducted by using the following international database tools: PsycINFO, MedLine Social Science Index, Scopus, Web of Science, published from 1960 until 2022. Results: We analyzed 63 scientific studies to assess the advantages and limits of several psychometric and physical scar evaluation scales. Conclusions: The researchers analyzed in this review highlight the advantages and limitation of existing instruments, evidencing the demand for future scar evaluation instruments and a scar-assessing algorithm that takes into account the physical, aesthetic, psychosocial, and legal consequences of scars

Clinical Outcomes Following the Early Application of Multimodal Scar Programs for Facial Incisional Wounds

Background: Even though scars are major issues for patients who undergo facial lacerations, programs for their prevention and early management are not well established. The purpose of this study was to evaluate the clinical outcomes of prophylactic scar assessments and early scar interventions in patients with lacerations. Patients and methods: A total of 116 patients underwent suture line and scar prevention treatment in the emergency room from 2014 to 2015. In the retrospective study, 46 patients who met all the criteria were included in the study. They were assigned to one of the following two scar prevention programs: the standard scar program for prevention, which included taping, silicone sheets, and ointments, and the multimodality scar program for treatment, which included triamcinolone, botulinum toxins, or CO2 fractional lasers. The patterns of early scar program were investigated for the standard scar prevention program and the multimodality scar management program, and we evaluated the scar assessment scores of the patients at 3 and 6 months. Results: Scar scores for the patients who received multimodality scar management showed statistically significant improvements in Patient Scar Assessment (PSA) scales, Stony Brook Scar Evaluation Scales (SBSES), Vancouver Scar Scale (VSS) scores, and Visual Analog Scar (VAS) scales (the p values were 0.008, 0.007, 0.017, and 0.01, respectively). Conclusion: The multimodality scar program is more effective for scar prevention than the standard scar program. Level of evidence iv: 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 .restrictio

Textbook on Scar Management [electronic resource] : State of the Art Management and Emerging Technologies /

This text book is open access under a CC BY 4.0 license. Written by a group of international experts in the field and the result of over ten years of collaboration, it allows students and readers to gain to gain a detailed understanding of scar and wound treatment – a topic still dispersed among various disciplines. The content is divided into three parts for easy reference. The first part focuses on the fundamentals of scar management, including assessment and evaluation procedures, classification, tools for accurate measurement of all scar-related elements (volume density, color, vascularization), descriptions of the different evaluation scales. It also features chapters on the best practices in electronic-file storage for clinical reevaluation and telemedicine procedures for safe remote evaluation. The second section offers a comprehensive review of treatment and evidence-based technologies, presenting a consensus of the various available guidelines (silicone, surgery, chemical injections, mechanical tools for scar stabilization, lasers). The third part evaluates the full range of emerging technologies offered to physicians as alternative or complementary solutions for wound healing (mechanical, chemical, anti-proliferation). Textbook on Scar Management will appeal to trainees, fellows, residents and physicians dealing with scar management in plastic surgery, dermatology, surgery and oncology, as well as to nurses and general practitioners.(see attached PDF for latest version) Foreword -- Preface -- I Semiology of scars, classifications and scoring -- 1 Biology and scar formation -- 2 Epidemiology of scars and their consequences -- 3 Scar symptoms: itching, redness, thickness, contractures, colour, hyper/hypochromia, psychological disorders -- 4 International classification and semiology od scars -- 5 Scar evaluation scales (Vancouver, POSAS, Manchester) -- 6 Assessment technologies (cutometer, laser Doppler, 3D imaging, stereophotogrammetry) -- II Scars management and Evidence-based medicine -- 7 Non-invasive technologies (lasers fractional ER Yag, pulsed dye, fractional CO2, silicone, pressure garments, postop devices) and psychological management -- 8 Semi invasive technologies (injections corticoteroids, antimitotic, needling) -- 9 Invasive techniques (surgery with local flaps, resurfacing, skin substitutes, microsurgical flaps, fat injections, others) -- 10 Specific scar management depending on anatomical features (face, hair, breast, hand, joints, foot) -- 11Cosmetic requirements depending on age and social considerations -- III State- of- the –Art Scar management technologies -- 12 Recently developed new technologies (mechanical, chemical) -- 13 Cultural and traditional approaches -- 14 Cellular skin substitutes -- 15 New drugs for scar treatment -- 16 Vacuum massage in scar treatment -- 17 Shock wave therapy for scar treatment -- Subject Index.This text book is open access under a CC BY 4.0 license. Written by a group of international experts in the field and the result of over ten years of collaboration, it allows students and readers to gain to gain a detailed understanding of scar and wound treatment – a topic still dispersed among various disciplines. The content is divided into three parts for easy reference. The first part focuses on the fundamentals of scar management, including assessment and evaluation procedures, classification, tools for accurate measurement of all scar-related elements (volume density, color, vascularization), descriptions of the different evaluation scales. It also features chapters on the best practices in electronic-file storage for clinical reevaluation and telemedicine procedures for safe remote evaluation. The second section offers a comprehensive review of treatment and evidence-based technologies, presenting a consensus of the various available guidelines (silicone, surgery, chemical injections, mechanical tools for scar stabilization, lasers). The third part evaluates the full range of emerging technologies offered to physicians as alternative or complementary solutions for wound healing (mechanical, chemical, anti-proliferation). Textbook on Scar Management will appeal to trainees, fellows, residents and physicians dealing with scar management in plastic surgery, dermatology, surgery and oncology, as well as to nurses and general practitioners