The mortality and morbidity from burns have diminished tremendously over the last six to seven decades. However, these do not truly reflect whether the victim could go back to society as a useful person or not and lead a normal life because of the inevitable post-burn scars, contractures and other deformities which collectively have aesthetic and functional considerations. This article gives an overview of the post-burn scars and scar contractures, especially their prevention, minimisation and principles of management.
Goel, Arun; Shrivastava, Prabhat
This report present an evaluation 13 consecutive cases of severe burn scar contracture of the axilla and investigates the factors that influence functional improvement. The operation was performed at various times during the period from 3 months to 63 years after the initial burn wound healed. The active range of shoulder abduction before the operation in these patients was restricted
Aya Tanaka; Mitsuo Hatoko; Hideyuki Tada; Masamitsu Kuwahara
Background. Severe anterior post-burn contracture (PBC) of the neck poses the anaesthesiologist some difficult problems and results in difficult intubation when extension of the atlanto-occipital joint is impaired. Such patients must therefore have the PBC scar released before other procedures are performed, in order to ensure airway control. Objectives. To show our experience with quick surgical neck release of patients with severe anterior PBC of the neck to facilitate direct laryngoscopy and orotracheal intubation (OTI). Material and methods. A prospective study of patients with severe anterior PBC of the neck was carried out from January 2003 to December 2007 in the Burns Unit of Mosul Teaching Hospital in Mosul, Iraq. The patients were given ketamine, after which a release incision was made over the anterior PBC of the neck scar. OTI was then performed successfully. Results. Twelve patients with severe neck PBC (3 males, 9 females; age range, 7-37 yr; mean age, 20 yr) all had successful OTI after PBC release under intravenous ketamine. None showed any complications attributed to the anaesthesia. PMID:21991181
Al-Zacko, S M; Al-Kazzaz, D A
Summary Background. Severe anterior post-burn contracture (PBC) of the neck poses the anaesthesiologist some difficult problems and results in difficult intubation when extension of the atlanto-occipital joint is impaired. Such patients must therefore have the PBC scar released before other procedures are performed, in order to ensure airway control. Objectives. To show our experience with quick surgical neck release of patients with severe anterior PBC of the neck to facilitate direct laryngoscopy and orotracheal intubation (OTI). Material and methods. A prospective study of patients with severe anterior PBC of the neck was carried out from January 2003 to December 2007 in the Burns Unit of Mosul Teaching Hospital in Mosul, Iraq. The patients were given ketamine, after which a release incision was made over the anterior PBC of the neck scar. OTI was then performed successfully. Results. Twelve patients with severe neck PBC (3 males, 9 females; age range, 7-37 yr; mean age, 20 yr) all had successful OTI after PBC release under intravenous ketamine. None showed any complications attributed to the anaesthesia.
Al-Zacko, S.M.; Al-Kazzaz, D.A.
The third year of the ACT proved to be a turning point for the burn rehabilitation study. During this past year, patient screening and subject enrollment with subsequent data collections began at seven participating facilities. Processes to support the AC...
Abstract: An 18-year old woman was admitted to Motahari Burn Center suffering from 30% burns. Treatment modalities were carried out for the patient and she was discharged after 20 days. Three to four months later she developed hypertrophic scar on her chest and upper limbs. At the same time she developed galactorrhea in both breasts and had a disturbed menstrual cycle four months post-burn. On investigation, we found hyperprolactinemia and no other reasons for the high level of prolactin were detected. She received treatment for both the hypertrophic scar and the severe itching she was experiencing. After seven months, her prolactin level had decreased but had not returned to the normal level. It seems that refractory hypertrophic scar is related to the high level of prolactin in burns patients.
Karimi, Hamid; Nourizad, Samad; Momeni, Mahnoush; Rahbar, Hosein; Momeni, Mazdak; Farhadi, Khosro
Peri-anal contracture lead to intestinal obstruction whenever there is involvement of anal orifice. In this case anus and peri-anal skin up to two cm was normal; however both gluteal folds were fused because of post burn scar leaving a very small opening which lead to faecal impaction and sub acute intestinal obstruction.
Thakur, Jagdeep S; Chauhan, CGS; Diwana, Vijay K; Thakur, Anamika
The subcutaneous pedicle rhomboid flap is a relatively new technique in the treatment of linear, wide or quadratic postburn scar contractures with two or more contracture lines. The effectiveness of the rhomboid flap depends on lengthening the contracture band by relaxation incisions and closing the emerged defect by suturing the rhomboid flap in V–Y and Y–V advancement. The technique is
Nilgün Markal Erta?; Ahmet Küçükçelebi; Nebil Bozdo?an; Selim Çelebio?lu
In Asian patients, ablative laser therapies are seldom used to treat burn scars due to posttreatment dyschromia, especially when nonfacial areas are treated. The non-ablative 1550-nm erbium-doped fractional photothermolysis system, although effective, requires multiple treatment sessions. In the authors hands, a 34-year-old Korean woman achieved improved atrophy, contracture, texture and color of a burn scar on her chest after two treatments spaced six weeks apart with an ablative 10,600 nm CO2 fractional laser system (Ultrapulse Encore Laser, Lumenis Inc., Santa Clara, CA). PMID:20214184
Cho, Sung Bin; Lee, Sang Ju; Chung, Won Soon; Kang, Jin Moon; Kim, Young Koo
Z-plasty is one of the most widely employed techniques in plastic surgery and mainly serves the following purposes: elongation along the axis of the scar, dispersal of the scar followed by breaking up the straight-line scar and realigning the scar within the lines of minimal tension. It is useful especially to release linear-scar contracture, yet difficult for wide scars. This report describes a novel technique to release contracture effectively for any wide scars using a new design called double combined Z-plasty. The design is simple. The main limb is set to incise the wide scar, and this main limb is shared as a peripheral limb by two other Z-plasty designs. From the main limb, each central limb is designed along the margin of the scar in the opposite direction. The main and central limbs have 90° between them. Other peripheral limbs are then designed facing laterally to the intact skin to make 60° for the central limb. After skin incision, two triangular intact skin flaps could be inserted into the wide scar from both sides, making it possible to release contracture. We performed this technique on eight patients. All wounds healed well and scar contracture was satisfactorily released. This procedure is very useful for wide-scar contracture, compared to conventional Z-plasty. PMID:23434195
Yotsuyanagi, Takatoshi; Yamashita, Ken; Gonda, Ayako; Kato, Shinji; Sugai, Asuka; Yamada, Tetsuo; Kayama, Musashi; Ikeda, Kanae; Yamauchi, Makoto; Saito, Tamotsu
Significant neck burns may lead to deforming lateral flexion and rotation contractures. A two-device splinting regimen has been designed to prevent such contractures. In the acute phase, the Dynamic Antitorticollis Strap is applied while the patient is in bed to gently rotate the head and neck toward the neutral position. This dynamic strap includes a Velfoam headband attached to Thera-Band secured to the patient's bed. The antitorticollis neck splint is used in the rehabilitation phase and can be serially adjusted to correct lateral flexion contractures of the neck. Thermoplastic material is cut from a modified neck splint pattern and draped over the temporaloccipital region and anterior/posterior shoulder ipsilateral to the contracture and the anterior and contralateral aspect of the neck. The combined use of these devices during the scar maturation phase provides therapists with alternatives in preventing burn scar torticollis. PMID:14501406
Serghiou, Michael A; McLaughlin, Alex; Herndon, David N
Background The thin and pliable skin of the neck is a region with multidirectional activity, and postburn scar contractures tend to form there easily. The supraclavicular flap is used to correct neck scar contractures. Its main vascular supply is the supraclavicular artery, and it can be harvested as either a skin pedicle flap or an island flap (vascular pedicle flap). Objective In this article, a total of 41 flaps are studied retrospectively and their efficacy in reconstruction of post-burn neck scar contractures is discussed. Also donor-site morbidity, patient satisfaction, and complications were evaluated. Patients and Methods Between November of 2004 and January of 2009, 41 supraclavicular flaps were used for reconstructions in 32 patients at the authors’ hospital. Twenty-four of these flaps were skin pedicle flaps, and 17 were island flaps. The range of flap size was 18 ± 6 cm in length, and 9 ± 3 cm in width. Pre-expansion was performed in 14 flaps. Primary closure of donor site was performed in 35 flaps. Results Thirty-seven of the 41 flaps survived completely, but there were three cases of distal necrosis (10-30%), and one case of complete flap necrosis. Twenty-nine of the 32 patients were satisfied with both the functional and aesthetic results. Conclusions Scarring of the neck produces problems with function, and appearance. In our view, the supraclavicular flap, a thin flap of good texture, is an excellent and highly reliable flap for covering defects of the anterior neck. This flap is easy to harvest, with good functional and aesthetic results.
Loghmani, Shahriar; Eidy, Mohammad; Mohammadzadeh, Mahdi; Loghmani, Alireza; Raigan, Fahimeh
With the advances there have been in the care of burn injuries in the past decade, patients are now surviving much larger area burns than previously. This is not sufficeint - there must be good quality life, with good function and good appearance in both ...
S. P. Pegg
Summary Post-burn contracture and deformities of the foot and ankle joint with respect to other localizations account for 3.5-5% of cases. Functional disturbances of the foot and ankle joint affect the functioning of the entire lower joint, its statics, and the patient’s gait and bearing, and can even lead to distorted pelvis, curvature of the spine, and other disturbances. Between 1990 and 2002 we treated 69 cases for a total number of 76 foot and ankle joint deformities enrolled in the study. The choice of plastic operation was made on the basis of the severity and localization of the injury - we used local uninjured tissues and soft scars to make trapezoid, Z-plasty or other shaped flaps and free grafts placed on the area of the excised scars. We observed the follow-up during a period of one to eight years in 57 patients with burn deformities of the ankle (82.6% of the overall number of patients observed in the clinic). In 41 cases (71.9%) the deformities were completely eliminated and in 13 cases (22.8%) the results were satisfactory; three patients (5.3%) had poor results. The victims of burns in the ankle joint must be kept under constant examination if scarring is present, with the danger of retarded growth of the burned foot joint and the development of secondary bone-joint changes. Early surgery is advised depending on severity of the contracture.
Although children with burn scars are reported to have positive self-concepts, social and sexual maturation can be expected to stimulate anxiety, depression and diminished self-esteem in adolescents with disfiguring scars. This study examines complex self-regard of adolescents with burn scars. The following were hypothesized: (1) adolescents with disfiguring burn scars would view themselves as less competent than unburned normative samples;
Rhonda Robert; Walter Meyer; Sheryl Bishop; Laura Rosenberg; Luanne Murphy; Patricia Blakeney
The formation of hypertrophic scars is common following healing of the burn wound, particularly in children. The face is one of the areas of the body most frequently affected by burns. Scar formation as a result of burn wounds leads to contraction of the formed granulation tissue, which causes both aesthetic and functional impairment for the patient. Scarring has major psychological and physical repercussions. Scarring on the face and visible regions of the body can be very distressing for the patient. Prevention of scars involves early and continuous use of a compressive orthesis. However, their efficacy is often limited to the facial region because of the contours of this area of body. This paper describes a clinical case of post-burn hypertrophic scars treated with silicone gel sheeting applied with pressure under custom made auto-polymerizing resin stent. PMID:20657105
Padmanabhan, T V; Mohmad, Kasim; Gupta, Rajiv Kumar
Hypertrophic scarring after burns remains a major problem and is considered to be “common”. Pressure garments are commonly used as treatment even though there is little sound data that they reduce the prevalence or magnitude of the scarring. In 1999 we began a study of the efficacy of pressure garments on forearm burns. After studying 30 patients, mainly white adults,
Kristine M Bombaro; Loren H Engrav; Gretchen J Carrougher; Shelly A Wiechman; Lee Faucher; Beth A Costa; David M Heimbach; Frederick P Rivara; Shari Honari
Severe contractures that develop early following a burn may not improve with splinting and exercise treatment. An alternative treatment is serial casting, which has been used to promote increased range of motion, to facilitate patient compliance with positioning, and to prevent the patient from scratching the burned area. This case report describes the use of serial casting for resolution of ankle plantar-flexion contractures that occurred in the acute phase of burn injury. The child described in this case report sustained a 49% total body surface area scald burn and developed contractures within 1 week after injury. The contractures, which were not corrected with thermoplastic splints, improved with casting from 45 degrees of plantar flexion to neutral dorsiflexion over 2 months with biweekly cast changes. The patient had multiple skin grafts and progressed in functional activities. Serial casting is a conservative and effective modality in correcting contractures resulting from burns. Further documentation of the efficacy of this treatment approach is necessary to support its use in burn care throughout various stages of healing. PMID:7899484
Johnson, J; Silverberg, R
There are many problems in the anesthetic management of patients with scar contracture. In this case, a 41-year-old male with severe scar contracture on his face, neck, anterior chest, and both shoulders underwent surgery for resurfacing with flaps. We tried to awake fiberoptic orotracheal intubation with GlideScope® Video laryngoscope guide after surgical release of contracture under local anesthesia. We report a successful management of a patient with severe burn contracture achieved by combined effort of surgeons and anesthesiologists.
Lee, Hye-Kyoung; Yim, Ji-Yeon; Kang, Im-Hong
This study examined the potential usefulness of combining remote sensing data with hydrologic models and mapping tools available from Geographic Information Systems (GIS), to evaluate the effects of wildfire. Four subprojects addressed this issue: (1) validation of burn scar maps derived from the Advanced Very High Resolution Radiometer (AVHRR) with the National Fire Occurrence Database; (2) testing the potential of thermal MODIS (Moderate Resolution Imaging Spectroradiometer) data for near-real time burn scar and fire severity mapping; (3) evaluation of Landsat derived burn severity maps within WEPP through the Geo-spatial interface for the Water Erosion Prediction Project (GeoWEPP), and (4) predicting potential post-fire erosion for western U.S. forests utilizing existing datasets and models. Wildfire poses incredibly complex management problems in all of its stages. Today's land managers have the option of trying to mitigate the effects of a severe fire before it occurs by fuel management practices. This process is expensive especially considering the uncertainty of when and where the next fire in a given region will occur. When a wildfire does occur, deciding when to let it burn and when to suppress it may lead to controversial decisions. In addition to the threat to life and property from the fire itself, smoke emissions from large fires can cause air quality problems in distant airsheds. Even after the fire is extinguished, erosion and water quality problems may pose difficult management questions. Contributions stemming from these studies include improved burn scar maps for studying historical fire extent and demonstration of the feasibility of using thermal satellite data to predict burn scar extent when clouds and smoke obscure visible bands. The incorporation of Landsat derived burn severity maps was shown to improve post-fire erosion modeling results. Finally the potential post-fire burn severity and erosion risk maps generated for western US forests will be used for planning pre-fire fuel reduction treatments.
Miller, Mary Ellen
BACKGROUND: To date, many techniques for the surgical treatment of postburn scar contractures have been described. Some of the most popular techniques are Z-plasty, V-Y-plasty and their analogues. A major limitation of these techniques is that the excess tissue requires excision of the dog ear. The current study presents a new modification of the double-opposing Z- and V-plasty, called ‘K-M-N plasty’. METHODS: Twenty postburn scar contractures were successfully treated with K-M-N plasty. The postoperative results depict the versatility of this technique in the surgical treatment of postburn scar contractures, especially in the upper and lower extremities. RESULTS: There was no distal flap necrosis, and postoperative recovery was uneventful in all operated patients. K-M-N plasty is an effective and alternative method for the surgical treatment of postburn scar contractures. In addition, drawing and flap transpositions were not complicated. DISCUSSION: There are many advantages to using this technique: K-M-N plasty can be safely used when skin tension crosses the contracture line; it is superior to other local flaps because of its rich vascularity and mobility for superficial scars; it can be recommended to the inexperienced surgeon because it can be performed with ease; it is also an effective procedure for the pericontracture area due to its V limb (it can prevent recontracture); the colour and texture matches are more cosmetically acceptable, and the resultant contracture release is similar to other techniques; the dog ear formation is not seen; it can be performed under local anesthesia in most cases (not in children); and it has a shorter period of operation and hospitalization than other techniques.
Emsen, Ilteris Murat
Background: A post-burn flexion contracture of the knee joint is a disabling condition which interferes with an upright posture and a bipedal locomotion. Islanded perforator flaps have been used to resurface the tissue defect which is produced as a result of the contracture release. Despite their various advantages, they are limited by an increased tendency to undergo venous congestion. Perforator-plus flaps can be used to overcome this limitation, while retaining the merits of the islanded perforator flaps. Methods: Ninteen patients with post flame burn flexion contractures of the knee joints underwent surgical releases and coverages by various local fasciocutaneous perforator-plus flaps. The patients were followed up for 6 months and the various aspects of the functional and the aesthetic rehabilitations were assessed. Results: All the local fasciocutaneous perforator-plus flaps resurfaced the tissue defect over popliteal fossa with good colour and texture match and maintenance of the contour. None of the flaps had any significant early or delayed complications (which included venous congestions) which necessitated reoperations. All the patients were satisfied with the functional and aesthetic outcomes. Conclusion: Local fasciocutaneous perforator-plus flaps can be considered as one of the primary treatment modalities for the surgical release and reconstruction of post burn flexion contractures of the knee. PMID:23814737
Gupta, Madhumita; Pai, Ashwin A; Setty, Ravi R; Sawarappa, Raghavendra; Majumdar, Bijay Kumar; Banerjee, Tibar; Kanoi, Aditya; Bhattacharya, Abhimanyu
Background: A post-burn flexion contracture of the knee joint is a disabling condition which interferes with an upright posture and a bipedal locomotion. Islanded perforator flaps have been used to resurface the tissue defect which is produced as a result of the contracture release. Despite their various advantages, they are limited by an increased tendency to undergo venous congestion. Perforator-plus flaps can be used to overcome this limitation, while retaining the merits of the islanded perforator flaps. Methods: Ninteen patients with post flame burn flexion contractures of the knee joints underwent surgical releases and coverages by various local fasciocutaneous perforator-plus flaps. The patients were followed up for 6 months and the various aspects of the functional and the aesthetic rehabilitations were assessed. Results: All the local fasciocutaneous perforator-plus flaps resurfaced the tissue defect over popliteal fossa with good colour and texture match and maintenance of the contour. None of the flaps had any significant early or delayed complications (which included venous congestions) which necessitated reoperations. All the patients were satisfied with the functional and aesthetic outcomes. Conclusion: Local fasciocutaneous perforator-plus flaps can be considered as one of the primary treatment modalities for the surgical release and reconstruction of post burn flexion contractures of the knee.
Gupta, Madhumita; Pai, Ashwin A.; Setty, Ravi R.; Sawarappa, Raghavendra; Majumdar, Bijay Kumar; Banerjee, Tibar; Kanoi, Aditya; Bhattacharya, Abhimanyu
This paper reviews the new progress in the research of fractional carbon dioxide laser in treating hypertrophic scar after burn injury, which remains a challenging problem for burn care surgeons. There have been many traditional therapeutic approaches, such as compression remedy, operation, and so on. However, a satisfactory method is lacking to date. In recent years, the newly developed fractional carbon dioxide laser has been employed to treat different kinds of scars, and it has been proved to be effective in terms of an improvement of scar color, texture, and rigidity. It seems to be a promising method for scar treatment in future. PMID:23327918
Wang, Hai-bo; Fang, Yong; Yu, Wei-rong
The plan of burn scar management of the Burn Unit at the Women's and Children Hospital is based on the following principles: early excision and grafting, close monitoring in a designated Burn Clinic and the individualised use of “contact media”. Contact media are grouped as adhesive contact media, contact media without pressure and contact media with pressure. Hypafix is our
R. B. Davey
Marjolin ulcers are scar carcinomas most often arising in old burn injuries. They arise mostly in the extremities. We report medical history of a 50-year-old female suffering from a scar carcinoma on her right cheek which was histopathologically identified as a mean differentiated squamous cell carcinoma. PMID:22425392
El Hani, I; Touil, H; Romdhane, E; Bouzaiene, M; Zinelabdine, M T
Scar formation and fibrosis often cause devastating disabilities in children suffering severe burn injury. In contrast to the child, the fetus has the ability to heal skin injury without scar formation, and instead with regeneration of epithelial and mesenchymal tissues and restoration of normal skin architecture. In this paper we review those unique features of the fetus and fetal wound
D. L. Cass; M. Meuli; N. S. Adzick
Suppression of hypertrophic scar generation in an animal model by treatment with plasma is reported. Contact burn following mechanical stretching was used to induce scar formation in mice. Exposure to the plasma tended to reduce the scar area more rapidly without affecting vitality. The treatment resulted in decreased vascularization in the scar tissue. Plasma-treated scars showed mild decrease in the thickness of hypertrophic tissues as shown by histological assessment. Finally, we showed that plasma treatment induced cell death and reactive oxygen species generation in hypertrophic scar fibroblast. All of the results support that plasma treatment can control scar generation.
Hoon Lee, Dae; Lee, Jae-Ok; Jeon, Wonju; Choi, Ihn-Geun; Kim, Jun-Sub; Hoon Jeong, Je; Kang, Tae-Cheon; Hoon Seo, Cheong
We report a case of a melanoma arising after about 10 years after a burn injury. This is an uncommon example of a carcinogenetic event that could be prevented or diagnosed early. Usually, the mutagenic event clinically appears many years after the burn especially if it was not treated correctly with a careful surgical approach. The average time of latency could be found in literature as 46.5 years from the burn, whereas our case was only 10. A frequent and very long follow-up of the burn scars could represent a valid prophylactic option to avoid neoplastic proliferation if the tumor appears. PMID:22627497
Ribero, Simone; Grassi, Marcella; Caliendo, Virginia; Lauro, Danilo; Macripò, Giuseppe
\\u000a To achieve optimal function and independence, an individual relies on the combined use of a number of treatment modalities\\u000a available to therapists (Simons et al., 2003). This chapter provides an overview of (1) classification and epidemiology of burn injury; and (2) intervention modalities\\u000a that aim to minimize impairment to body structures and body functions after burn injury, by using positioning
This invention pertains to a composition for controlling wound scar production containing a calcium antagonist and a protein synthesis inhibitor. The method can be used to minimize wound scars, such as hypertrophic wound healing disorders keloids and burn scar contractures in humans or other mammals, particularly those individually prone to excesssive scarring Calcium antagonist treatment can also be used to control diseases associated with excessive scarring. such as cirrhosis of the liver, constructive pericarditis Dupuytren's disease of the hand, plantar fibrosis of the foot, and various other fibromatoses.
Lee; Raphael C. (Chicago, IL)
Boreal forests comprise one third of global forested area and are the largest terrestrial carbon store. Forest fires are the regions most dynamic disturbance factor, occurring mainly in Siberia, Russian Far East, Canada and Alaska, and these fires represent a globally important release of terrestrial carbon to the atmosphere, via the burning of vegetation and organic soils. Currently the boreal
Heiko Balzter; M. C. Gonzalez; F. Gerard; David Riaño
It is estimated worldwide that over 6 million people per annum experience a burn injury. Despite advances in management and improved survival rates, the incidence of hypertrophic scarring remains high. These scars are particularly common after burns and are often raised, red, hard and may cause abnormal sensations. Such pathological scarring can lead to severe functional impairment, psychological morbidity, and costly long term healthcare. Wound healing is an inherent process which restores the integrity of the skin after injury and although scarring is a frequent by-product, the scarless wound healing observed in early human gestational fetuses suggests that it is not an essential component of the response. This has lead to a large body of research attempting to understand the mechanisms behind scarring and in turn prevent it. One of the main focuses of recent research has been the role played by the growth factor TGF-? in the process of both wound healing and scar formation. The three isoforms (TGF-?1, TGF-?2 and TGF-?3) appear to have overlapping functions and predominantly mediate their effects through the intracellular SMAD pathway. Initial research suggested that TGF-?1 was responsible for the fibrotic scarring response whereas the scarless wound healing seen in fetal wounds was due to increased levels of TGF-?3. However, the reality appears to be far more complex and it is unlikely that simply altering the ratio of TGF-? isoforms will lead to scarless wound healing. Other aspects of the TGF-? system that appear promising include the downstream mediator CTGF, the proteoglycan decorin and the binding protein p311. Other putative mechanisms which may underlie the pathogenesis of hypertrophic scars include excessive inflammation, excessive angiogenesis, altered levels of matrix metalloproteinases, growth factors, and delayed apoptosis of fibrotic myofibroblasts either due to p53 genetic alterations or tensile forces across the wound. If an effective treatment for hypertrophic scars following burns injury is to be developed then further work must be carried out to understand the basic mechanisms of pathological scarring. PMID:22928164
Penn, Jack W; Grobbelaar, Adriaan O; Rolfe, Kerstin J
Hypertrophic scars and keloids are challenging to manage, particularly as sequelae of burns in children in whom the psychologic burden and skin characteristics differ substantially from adults. Prevention of hypertrophic scars and keloids after burns is currently the best strategy in their management to avoid permanent functional and aesthetical alterations. Several actions can be taken to prevent their occurrence, including parental and children education regarding handling sources of fire and flammable materials, among others. Combination of therapies is the mainstay of current burn scar management, including surgical reconstruction, pressure therapy, silicon gels and sheets, and temporary garments. Other adjuvant therapies such as topical imiquimod, tacrolimus, and retinoids, as well as intralesional corticosteroids, 5-fluorouracil, interferons, and bleomycin, have been used with relative success. Cryosurgery and lasers have also been reported as alternatives. Newer treatments aimed at molecular targets such as cytokines, growth factors, and gene therapy, currently in developing stages, are considered the future of the treatment of postburn hypertrophic scars and keloids in children. PMID:18650721
Berman, Brian; Viera, Martha H; Amini, Sadegh; Huo, Ran; Jones, Isaac S
Hand burns are common injuries in which early accurate diagnosis of the severity of the injury and active surgical treatment can save it or diminish the permanent disability caused by the thermal trauma. During the four year period of 1976--1979 we treated 45 patients with acute hand burns; secondary surgery was performed in 29 scarred and contracted hands. Deep dermal or subdermal (III degree) burns were either immediately excised to the vital tissue (within 6 hr postburn) or early afterwards (within 1--7 days post injury). The reconstruction of the excised areas was made by free skin grafting in 43 hands. If deep structures were exposed, subsequent reconstructions were used: local, groin, or free flaps. The aims in treatment of scarred hands were to restore function and to repair unstable scars. The following secondary procedures, often combined in a one-stage operation, were performed: scar excision and regrafting, web space correction, groin flap reconstruction, digital joint arthrodesis or capsulectomy, tendon transfer, and spherical osteotomy. PMID:7008687
Asko-Seljavaara, S; Kilpi, M L; Hytönen, M; Sundell, B
Assessing burn scars from photographs is a common practice given the growing trend to support health service delivery via electronic media (eg, email, videoconferencing). Scar rating scales, originally designed for in-person assessment, have been used to rate scars from photographic images. Evidence for the reliability of this practice is lacking. Five raters completed three scar rating scales (Patient and Observer Scar Scale, Manchester Scar Scale, modified Vancouver Scar Scale), both in-person and using photographs on 12 participants (seven male, five female) with 18 scar areas (3?×?3?cm). Interrater reliability for the scar parameters of vascularity, color, contour, pliability, and overall opinion achieved intraclass correlation coefficient values of between 0.71 and 0.87 (in-person) and 0.72 and 0.77 (using photographs) for multiple raters. The level of agreement between in-person and photographic assessment was below acceptable levels, which brings into question construct validity when scar rating scales are used in a way for which they were not designed. Reliability estimates in this study were likely reduced by the underrepresentation of scars in the more severe range. This limitation needs to be addressed in future research. Advances are required in the development and refinement of burn scar rating scales, specifically for photographic use, given their routine use in clinical care. PMID:23271058
Simons, Megan; Ziviani, Jenny; Thorley, Michelle; McNee, Jessamine; Tyack, Zephanie
Burn injury is often a devastating event with long-term physical and psychosocial effects. Burn scars after deep dermal injury are cosmetically disfiguring and force the scarred person to deal with an alteration in body appearance. In addition, the traumatic nature of the burn accident and the painful treatment may induce psychopathological responses. Depression and post-traumatic stress disorder (PTSD), which are prevalent in 13-23% and 13-45% of cases, respectively, have been the most common areas of research in burn patients. Risk factors related to depression are pre-burn depression and female gender in combination with facial disfigurement. Risk factors related to PTSD are pre-burn depression, type and severity of baseline symptoms, anxiety related to pain, and visibility of burn injury. Neuropsychological problems are also described, mostly associated with electrical injuries. Social problems include difficulties in sexual life and social interactions. Quality of life initially seems to be lower in burn patients compared with the general population. Problems in the mental area are more troublesome than physical problems. Over a period of many years, quality of life was reported to be rather good. Mediating variables such as low social support, emotion and avoidant coping styles, and personality traits such as neuroticism and low extraversion, negatively affect adjustment after burn injury. Few studies of psychological treatments in burn patients are available. From general trauma literature, it is concluded that cognitive (behavioral) and pharmacological (selective serotonin reuptake inhibitors) interventions have a positive effect on depression. With respect to PTSD, exposure therapy and eye movement reprocessing and desensitization are successful. Psychological debriefing aiming to prevent chronic post-trauma reactions has not, thus far, shown a positive effect in burn patients. Treatment of problems in the social area includes cognitive-behavioral therapy, social skills training, and community interventions. Sexual health promotion and counseling may decrease problems in sexual life.In conclusion, psychopathology and psychological problems are identified in a significant minority of burn patients. Symptoms of mood and anxiety disorders (of which PTSD is one) should be the subject of screening in the post-burn phase and treated if indicated. A profile of the patient at risk, based on pre-injury factors such as pre-morbid psychiatric disorder and personality characteristics, peri-traumatic factors and post-burn factors, is presented. Finally, objective characteristics of disfigurement appear to play a minor role, although other factors, such as proneness to shame, body image problems, and lack of self-esteem, may be of significance. PMID:12680803
Van Loey, Nancy E E; Van Son, Maarten J M
In the European context, Portugal presents the highest number of fire occurrences and has the largest area affected by wildfires. Like other southern regions of Europe, Portugal has experienced a dramatic increase in fire incidence during the last few decades that has been attributed to modifications in land-use as well as to climatic changes and associated occurrence of weather extremes. Wildfire activity also presents a large inter-annual variability that has been related to changes in the frequency of occurrence of atmospheric conditions favorable to the onset and spreading of large-fires. Since 1990, the Portuguese Authority for Forests (AFN) has been producing yearly maps of fire perimeters under a protocol with the Department of Forest Engineering of the Institute of Agronomy (DEF/ISA). The AFN fire atlas uses end of fire season Landsat TM/ETM imagery to map all fire perimeters with area larger than 5ha. Because it relies on end-of-season imagery, the atlas provides a spatial snapshot of the yearly area burned, and dates of burn for individual events cannot be estimated. Such information is nevertheless crucial to understand the fire regime and fire seasonality and to disentangle the complex interactions among fire, land cover and meteorology. The aim of the present work is to develop an automated procedure that allows using time series of moderate resolution imagery, such as the one provided by the MODIS instrument on-board TERRA and AQUA, to assign dates of burning to scars larger than 500 ha in the Landsat based fire atlas. The procedure relies on the so-called (V,W) burned index that uses daily reflectance obtained from the 1km MODIS Level 1B calibrated radiance from bands 2 (NIR) and 20 (MIR). The algorithm detects persistent changes in the (V,W) burned index time series, within each Landsat burned scar. The day of maximum change is then identified by means of a discrimination index, together with thresholds from the (V,W) time series. A spatial filter is finally applied to remove the outliers. An assessment of the temporal accuracy of the algorithm was conducted for the year 2005. For this year, Landsat based fire scars larger than 500ha have an associated detection date, based on field information provided by the AFN. The detection date is here assumed as ignition date of each scar. It is also assumed that each scar corresponds to a single fire event. Using 78 fire scars, we computed the time difference, in days, between the detection date and the date of burn, estimated by the algorithm. Our results show that 70% of all scars were correctly dated by the algorithm with differences to the AFN detection date up to three days. These correspond to 83% of the overall burned area used in the accuracy assessment.
DaCamara, C. C.; Libonati, R.; Barros, A.; Gaspar, G.; Calado, T. J.
The aims of burn reconstruction should be to preserve, restore, and maintain function and appearance so the patient can recover a social life. Reconstruction surgery is delayed until the scar tissue has fully matured; it occurs generally by 9 to 12 months or more (merits of vitro-pressure test). Exception in presence of severe contracture (growth disturbance, unstable scars, corneal exposure with ectropion, severe microstomia) Occupational and physical therapy, scar management, compressive techniques, psychotherapy are all integral components of burn rehabilitation, but the place of plastic surgeon is fundamental all along the process. PMID:21924538
Scald injuries to the feet are relatively common in young children. In a minority of cases, contracture formation can lead to permanent disability. We present a new technique, which provides a simple yet functional form of splintage in the treatment of the contractures.
Sukh S Rayatt; Paul Grew; Barry W. E. M Powell
OBJECTIVE: After burn injuries, scarred skin lacks elasticity, especially in hypertrophic scars. Topical treatment with tretinoin can improve the appearance and quality of the skin (i.e., texture, distensibility, color, and hydration). The objective of this prospective study was to examine the effects of treatment with 0.05% tretinoin for one year on the biomechanical behavior and histological changes undergone by facial skin with post-burn scarring. Setting: Tertiary, Institutional. METHOD: Fifteen female patients who had suffered partial thickness burns with more than two years of evolution were selected. Skin biopsies were obtained initially and after one year of treatment. The resistance and elastance of these skin biopsies were measured using a mechanical oscillation analysis system. The density of collagen fibers, elastic fibers, and versican were determined using immunohistochemical analysis. RESULTS: Tretinoin treatment significantly lowered skin resistance and elastance, which is a result that indicates higher distensibility of the skin. However, tretinoin treatment did not significantly affect the density of collagen fibers, elastic fibers, or versican. CONCLUSION: Topical tretinoin treatment alters the mechanical behavior of post-burn scarred skin by improving its distensibility and thus leads to improved quality of life for patients.
Dematte, Maria Fernanda; Gemperli, Rolf; Salles, Alessandra Grassi; Dolhnikoff, Marisa; Lancas, Tatiana; Saldiva, Paulo Hilario Nascimento; Ferreira, Marcus Castro
BACKGROUND: Burns leave patients with long-term physical scarring. Children with scarring are required to face challenges of reintegration into their community, including acceptance of an altered appearance and acceptance by others. This can be difficult given society's preoccupation with physical appearance. Limited research exists investigating validity of cosmetic camouflage as a psychosocial intervention for children with scarring. This study investigated whether using cosmetic camouflage (Microskin™) had a positive impact on health-related quality of life, self-concept and psychopathology for children and adolescents (8-17 years) with burn scarring. METHOD: A prospective multi-centre randomised controlled trial was conducted across Australian and New Zealand paediatric hospitals. 63 participants (49 females, mean age 12.7±2.1 years) were enrolled. Data points were baseline (Time 1) and at 8 weeks (Time 2) using reliable and valid psychometric measures. RESULTS: Findings indicate there were significant improvements in socialisation, school and appearance scales on the Paediatric Quality of Life Inventory and psychopathology scores particularly peer problems decreased. However self-concept remained stable from baseline throughout intervention use. CONCLUSION: Cosmetic camouflage appears to have a positive impact on quality of life particularly socialisation. Cosmetic camouflage is a valid tool to assist children with scarring to actively participate socially within their communities. PMID:23770131
Maskell, Jessica; Newcombe, Peter; Martin, Graham; Kimble, Roy
This pilot study investigates whether pressure and silicone therapy used simultaneously are more effective in treating multiple characteristics of hypertrophic scars than pressure alone. A pilot randomized controlled trial was conducted. Twenty-two participants with hypertrophic burn scars were randomized to receive Jobskin pressure garments and Mepiform silicone sheeting or Jobskin pressure garments alone. The Vancouver Scar Scale (VSS) was used to measure multiple scar characteristics at baseline, week 12, and week 24. No statistically significant difference was found in the rate of change of the VSS scores between the pressure therapy (PT) group and the pressure therapy and silicone group at week 12 or week 24; however, the mean scores of both groups reduced over 24 weeks. There were no statistically significant changes in the VSS subscores (scar height, vascularity, pliability, and pigmentation) from baseline to week 12 or week 24. A statistically significant relationship was observed between the VSS score and TBSA burned (<30%) in the PT group at baseline (P<.05), over 12 weeks (P<.05), and over 24 weeks (P<.05). Given the limitations of this study, especially the small sample size, further research is necessary before any firm conclusions can be drawn on this therapy approach. However, this pilot study has discussed the recurring issues in the research regarding these controversial treatments and has yielded potential for further investigation in a fully powered randomized controlled trial. PMID:19506491
Harte, Daniel; Gordon, Jude; Shaw, Maxine; Stinson, May; Porter-Armstrong, Alison
Tropical deforestation and forest degradation contribute to about 20% of the global greenhouse gas emissions and Indonesia is a leading emitter. Forests are certainly critical; but the peat soils beneath can store 30 times more carbon than the trees above. Indonesia has the fourth-largest area of peatland in the world, ranging from 30 to 45 million ha, which is approximately 10 - 12% of the global peatland resource. Fire has a long tradition in Indonesian land clearing, where almost all fires are related to human activities. The 1997 - 1998 fires throughout Indonesia caused significant haze and smoke-related health problems across Southeast Asia. Strong and weak El Niño events in 1998 and 2002 accelerated burning as soil was parched. Green house gas emissions from the fires were the source of 60% of all anomalies globally for 1997 - 2000, particularly from drained peatlands. In 2007/08 we participated in a study conducted by the World Wildlife Fund which focused on Sumatra's 8.3 million ha province of Riau, along the island's northeastern coastline. In this study CO2 emissions from deforestation and forest degradation, peat decomposition and burning over 17 years from 1990 - 2007 were estimated. Fire hotspot data for the years 1997 - 2000 from the NOAA AVHRR and MODIS sensors was used to identify burned peatland. Based on soil water availability the depths of peat burns were estimated. El Nino years with a water table of lower than 1.5 m propel intense burning so that a peat burn depth of 0.50 m was assumed, while normally only a peat burn depth of 0.15 m. Total emissions for the 1990 - 2007 period were estimated at 3.66 Gt CO2, composed of 1.17 Gt CO2 from deforestation, 0.32 Gt CO2 from forest degradation, 0.78 Gt CO2 from peat decomposition, and 1.39 Gt CO2 from peat burning. Average annual CO2 emissions were 0.22 Gt, equal to 58% of Australia's total CO2 annual emissions (including emissions/removals from LULUCF, in 2005); between 1990 and 2007, Riau produced more CO2 per year than the fourth-largest industrial nation, Germany, saved to achieve its Kyoto target. Since 1990, emissions from peat burning and peat decomposition have exceeded that of above ground biomass deforestation. These numbers show how important it is to have more accurate estimations for peat burn depth in the future. Until now few field measurements were made, which would require to know the fire affected area in advance or ignite peatland on purpose. Furthermore fire scars are quickly covered by regenerating vegetation. Another problem is the lack of a method without actually having to go into the field (e.g. through remote sensing techniques), due to the fact that many of the fire locations are remote and very difficult to access. We investigated if airborne light detection and ranging (LIDAR), an active laser pulse technology by which the height of objects can be precisely measured, can be used to determine the amount of peat burned during a fire event. From a LIDAR data set acquired in Central Kalimantan, Borneo, in 2007, one year after severe fires resulting from the 2006 El Niño drought, we calculated that the average depth of a burn scar was 0.30 ± 0.15 m .This was achieved through the construction of digital terrain models (DTMs) by interpolating the LIDAR ground return signals in burnt and adjacent unburned peatland. These calculated depths were compared to in situ measurements, which came to similar results. We believe that the method presented here to estimate burnt peat depth has the potential to considerably improve the accuracy of regional and global carbon emission models but would also be helpful for monitoring projects under the Kyoto Protocol like the Clean Development Mechanism (CDM) or the proposed Reducing Emissions from Deforestation and Degradation (REDD) mechanism.
Ballhorn, U.; Siegert, F.
During the 1997/98 El Niño-induced drought peatland fires in Indonesia may have released 13-40% of the mean annual global carbon emissions from fossil fuels. One major unknown in current peatland emission estimations is how much peat is combusted by fire. Using a light detection and ranging data set acquired in Central Kalimantan, Borneo, in 2007, one year after the severe peatland fires of 2006, we determined an average burn scar depth of 0.33 +/- 0.18 m. Based on this result and the burned area determined from satellite imagery, we estimate that within the 2.79 million hectare study area 49.15 +/- 26.81 megatons of carbon were released during the 2006 El Niño episode. This represents 10-33% of all carbon emissions from transport for the European Community in the year 2006. These emissions, originating from a comparatively small area (approximately 13% of the Indonesian peatland area), underline the importance of peat fires in the context of green house gas emissions and global warming. In the past decade severe peat fires occurred during El Niño-induced droughts in 1997, 2002, 2004, 2006, and 2009. Currently, this important source of carbon emissions is not included in IPCC carbon accounting or in regional and global carbon emission models. Precise spatial measurements of peat combusted and potential avoided emissions in tropical peat swamp forests will also be required for future emission trading schemes in the framework of Reduced Emissions from Deforestation and Degradation in developing countries. PMID:19940252
Ballhorn, Uwe; Siegert, Florian; Mason, Mike; Limin, Suwido
The hand is ranked among the three most frequent sites of burns scar contracture deformity. One of the major determinants of the quality of life in burns survivors is the functionality of the hands. Burns deformities, although largely preventable, nevertheless do occur when appropriate treatment is not provided in the acute situation or when they are part of a major burns. Reconstructive procedures can greatly improve the function of the hands. Appropriate choice of procedures and timing of surgery followed by supervised physiotherapy can be a boon for a burns survivor.
Sabapathy, S. Raja; Bajantri, Babu; Bharathi, R. Ravindra
Reconstruction of the burned breast poses several clinical challenges, since scarring can adversely affect the development, contour and positioning of the breast as well as the cosmetic appearance of the skin surface. Conventional management entails contracture release and thick split-thickness skin grafting. We investigated an alternative approach employing dermal regeneration template (Integra) for breast reconstruction in 12 consecutive patients who
R. Palao; P. Gómez; P. Huguet
Post-burn hypertrophic scars are characterized by increased collagen synthesis and hyperplasia, and may be associated with erythema, pain, dysesthesia, pruritus, and skin border elevation. Although the etiopathogenesis of hypertrophic scarring remains unclear, proinflammatory and profibrogenic cytokines are known to play an important role in general skin dysfunction. This study assessed mRNA expression, proteins, and type I receptors of tumor necrosis factor-alpha (TNF-?) and interleukin 1-beta (IL-1?) in normal skin, normotrophic and post-burn hypertrophic scars. Skin biopsies were obtained from 10 hypertrophic and 9 normotrophic scars, and 4 normal skin sites. Only post-burn scars covering more than 10% of the body were included. Ex vivo histopathological analysis evaluated scar maturity, in situ hybridization assessed mRNA expression, and cytokine protein and cytokine/cell colocalization were performed using single- and double-label immunohistochemistry, respectively. IL-1? is overexpressed in hypertrophic scars at the post-transcriptional level, associated primarily with keratinocytes and CD1a(+) cells. Type I receptors for TNF-? are overexpressed in blood vessels of hypertrophic scars. The coordinated overexpression of IL-1? and TNF-? type I receptor may maintain the fibrogenic phenotypes of hypertrophic scars, even those in "remission". PMID:22226222
Salgado, Rosa M; Alcántara, Luz; Mendoza-Rodríguez, C Adriana; Cerbón, Marco; Hidalgo-González, Christian; Mercadillo, Patricia; Moreno, Luis M; Alvarez-Jiménez, Ricardo; Krötzsch, Edgar
Transforming growth factor-?1 (TGF-?1) plays a key role in hypertrophic scar formation. A lot of studies have shown that TGF-?1 stimulates fibroblast proliferation, collagen production, and ?-smooth muscle actin (?-SMA) expression, inhibits matrix degradation and eventually leads to scar formation. Smad proteins are important intracellular mediators of TGF-?1 signaling, and Smad ubiquitination regulatory factor 2 (Smurf2), an ubiquitin ligase for Smads, plays critical roles in the regulation of TGF-?1/Smad signaling. It was reported that Smurf2 was abnormally expressed during the process of liver fibrosis and lung fibrosis. Hypertrophic scarring is a fibroproliferative disorder of the dermis that occurs following wounding. However, little is known about the expression of Smurf2 in hypertrophic scarring. We hypothesized that TGF-?1 signaling cannot be disrupted after wound epithelialization probably due to abnormal expression of Smurf2 in hypertrophic scar fibroblasts. In the present study, we found that hypertrophic scar fibroblasts exhibited increased Smurf2 protein and mRNA levels compared with normal fibroblasts, and the expression of Smurf2 gradually increased in hypertrophic scar fibroblasts after TGF-?1 stimulation. Furthermore, we transfected Smurf2 siRNA into hypertrophic scar fibroblasts, and we found that silencing the expression of Smurf2 in hypertrophic scar fibroblasts dramatically reduced TGF-?1 production, inhibited TGF-?1-induced ?-SMA expression and inhibited TGF-?1-induced collagen I synthesis. Our results suggest that the enhanced expression of Smurf2 is involved in the progression of hypertrophic scarring. PMID:21920670
Zhang, Zhi; Finnerty, Celeste C; He, Jing; Herndon, David N
Transforming growth factor-?1 (TGF-?1) plays a key role in hypertrophic scar formation. A lot of studies have shown that TGF-?1 stimulates fibroblast proliferation, collagen production, and ?-smooth muscle actin (?-SMA) expression, inhibits matrix degradation and eventually leads to scar formation. Smad proteins are important intracellular mediators of TGF-?1 signaling, and Smad ubiquitination regulatory factor 2 (Smurf2), an ubiquitin ligase for
Zhi Zhang; Celeste C. Finnerty; Jing He; David N. Herndon
We recently demonstrated that the accumulation of extracellular matrix in post-burn hypertrophic scarring (HSc) tissues is, in part, caused by an overexpression of mRNA for fibronectin, type I, and type III procollagen. Here, we report that five different fibroblast cell strains derived from HSc tissues are deficient in collagenase activity relative to paired fibroblasts from normal skin of the same
Aziz Ghahary; You J. Shen; Bernadette Nedelec; Rijian Wang; Paul G. Scott; Edward E. Tredget
Purpose We reviewed the results of cross finger flaps after surgical release and vigorous postoperative exercises for long-standing, severe flexion contractures of the Proximal Interphalangeal (PIP) joints of fingers. Materials and Methods In 9 patients, all contracted tissue was sequentially released and the resultant skin defect was covered with a cross-finger flap. The cause of the contracture was contact burn in 4, skin graft in 3, and a previous operation in 2. The mean follow-up period was 41.2 months. Results The mean flexion contracture/further flexion in the joints were improved from 73.4/87.8° to 8.4/95.4° at the last follow-up. A mean of 19.5° of extension was achieved with vigorous extension exercise after the operation. The mean gain in range of motion (ROM) was 79.4°. Near full ROM was achieved in 3 cases. There were no major complications. Conclusions In severe flexion contractures with scarring of the PIP joints of fingers, cross finger flaps after sufficient release and vigorous postoperative exercise seems to be a reasonable option to obtain satisfactory ROM of the joints.
Hahn, Soo Bong; Kang, Ho Jung; Kang, Eung Shick
Rehabilitation is an essential and integral part of burn treatment. It is not something which takes place following healing of skin grafts or discharge from hospital; instead it is a process that starts from day one of admission and continues for months and sometimes years after the initial event. Burns rehabilitation is not something which is completed by one or two individuals but should be a team approach, incorporating the patient and when appropriate, their family. The term ‘Burns Rehabilitation’ incorporates the physical, psychological and social aspects of care and it is common for burn patients to experience difficulties in one or all of these areas following a burn injury. Burns can leave a patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. The aims of burn rehabilitation are to minimise the adverse effects caused by the injury in terms of maintaining range of movement, minimising contracture development and impact of scarring, maximising functional ability, maximising psychological wellbeing, maximising social integration
Flexion contracture of the elbow is a common sequela of burn injury. Numerous methods have been suggested for release, including grafting, Z-plasty, Y-V flaps, local or distant fasciocutaneous flaps, muscle or myocutaneous flaps, free flaps, tissue expanders and non-surgical orthotics. In this article the authors present their experience with the propeller flap method in seven cases of elbow flexion contracture. Sufficient extension and an acceptable aesthetic outcome were obtained. Other benefits include easy design and rapid flap elevation that permits a single stage correction of the deformity without further sacrificing an artery or muscle. We think that the main disadvantage of the propeller flap is using the same skin that has suffered from the burn insult which has a poorer cosmetic result. Other than this and excluding deep burn injuries, we believe that the propeller flap is a useful alternative for elbow contracture release. PMID:16384651
Aslan, Gurcan; Tuncali, Dogan; Cigsar, Bulent; Barutcu, Ayse Yuksel; Terzioglu, Ahmet
Summary Burns of the front of the chest and abdomen and sometimes the front of the neck and axilla, mostly caused by flame in domestic accidents, are very common in Egypt. If deep, these burns can produce breast deformity in females either in childhood or in adolescence. This work considers 74 female breasts in 55 patients who had post-burn breast deformities due to accidents in childhood or early adulthood. The patients’ median age was 21 years (range, 13 to 42 years). The cause was scalding in 18 patients and flame in 37. The following conditions were found: upward contracture in 26 breasts (35%), 21 patients; downward contracture in 32 breasts (43%), 25 patients; and loss or distortion of the nipple/areola complex in 16 breasts (22%), 9 patients. Surgical correction included: Z-plasty, scar revision, scar excision and reconstruction by local flap or skin graft, and use of tissue expanders. Adequate projection of the reconstructed breast with the creation of a normal-looking inframammary fold was obtained. There were no major complications. Two patients had partial skin loss of the split-thickness graft, and partial loss of edges of the areola occurred in three cases. The burns thus caused various degrees of breast deformity and the corrective surgery varied accordingly. It is concluded that in such cases the general rules of scar revision have to be applied, correcting the contracture by Z-plasty or else by a local flap, if available, or by a split-thickness graft if the surrounding area is affected by post-burn scarring or if a large defect appears after complete release. Tissue expanders play a role in some if the scar area is surrounded by normal healthy tissue.
El-Otiefy, M.A.E.; Darwish, A.M.A.
Burns of the front of the chest and abdomen and sometimes the front of the neck and axilla, mostly caused by flame in domestic accidents, are very common in Egypt. If deep, these burns can produce breast deformity in females either in childhood or in adolescence. This work considers 74 female breasts in 55 patients who had post-burn breast deformities due to accidents in childhood or early adulthood. The patients' median age was 21 years (range, 13 to 42 years). The cause was scalding in 18 patients and flame in 37. The following conditions were found: upward contracture in 26 breasts (35%), 21 patients; downward contracture in 32 breasts (43%), 25 patients; and loss or distortion of the nipple/areola complex in 16 breasts (22%), 9 patients. Surgical correction included: Z-plasty, scar revision, scar excision and reconstruction by local flap or skin graft, and use of tissue expanders. Adequate projection of the reconstructed breast with the creation of a normal-looking inframammary fold was obtained. There were no major complications. Two patients had partial skin loss of the split-thickness graft, and partial loss of edges of the areola occurred in three cases. The burns thus caused various degrees of breast deformity and the corrective surgery varied accordingly. It is concluded that in such cases the general rules of scar revision have to be applied, correcting the contracture by Z-plasty or else by a local flap, if available, or by a split-thickness graft if the surrounding area is affected by post-burn scarring or if a large defect appears after complete release. Tissue expanders play a role in some if the scar area is surrounded by normal healthy tissue. PMID:21991241
El-Otiefy, M A E; Darwish, A M A
Successful treatment of dorsal foot burns is a challenge. By extrapolating from various treatments of dorsal hand burns the design of a static progressive splint was applied to the treatment of dorsal foot burns to prevent contracture deformities. The splint is composed of a base, dorsal thermoplastic piece, and Velcro strap. Soft hook and loop Velcro encircles the ankle and midfoot providing a base for the attachment of a Velcro strap. A thermoplastic piece is conformed to the dorsum of the toes and then affixed to the Velcro strap. The Velcro strap is then attached to the plantar surface of the base to create an adjustable static progressive stretch. This splint is designed to prevent dorsal foot contractures during the scar maturation phase of wound healing. PMID:11761399
To achieve the goals of burn wound coverage and prevention of burn scar contracture, the author applied very thick split-thickness (to mobile surfaces) and ordinary split-thickness (to nonmobile surfaces) skin grafting to burned wounds simultaneously. Using a Padgett dermatome to harvest very thick split-thickness skin (0.024-0.026 in) is a simple and time-saving procedure. The initial results were good and patients had a better outcome and shorter home stay before resuming work. PMID:20647934
A simple laser ablation monitoring during burn scar removal by KrF laser irradiation was studied to control laser fluence in real-time. Because, to obtain suitable surface for auto skin-graft, the laser fluence should be precisely controlled at each laser shot. We employed simple probe transmission method which could detect ejected material/phenomena from irradiated surface. The time-course of measured probe intensity contained a couple of attenuated peaks, which might corresponded to a shock wave front and debris plume. The delay time from laser irradiation to the debris plume peak appearance varied with the ablation fluence. The delay time of 1 J/cm2 (near ablation threshold) case prolonged 25% from 8 J/cm2 (far above threshold) case. Therefore, we think the delay time measurement by means of the simple probe transmission method may be available to attain the laser fluence control for nonuniform burn scar removal. The time-resolved photography and probe reflection method were also studied to understand the measured time-course of the transmitted probe intensity.
Nakajima, Akio; Arai, Tsunenori; Kikuchi, Makoto; Iwaya, Akimi; Arai, Katsuyuki; Inazaki, Satoshi; Takaoka, Takatsugu; Kato, Masayoshi
Burns are a leading cause of accidental injury and death. The American Burn Association statistics from 2001 to 2010 show that 68% of burns happen at home, 44% are from fires/flames, and 60% to 70% happen to white men. Smoke inhalation is the leading cause of adult death caused by fires. A patient with a 78% total body surface area burn has a 50% chance of survival. Burn injuries are described in terms of causative agents, depth, and severity. Crucial treatments for people with burns include assessment, stabilization, transfer to a burn unit, and fluid resuscitation. PMID:23692944
Ellison, Deborah L
Conventional therapy for burns has always produced a nightmarish illness for patients. The lack of the ability to prevent contractures often produces dysfunctional limbs and the ugly scars resulting from severe burns are an ongoing reminder of this lengthy painful illness. This study is to determine the effectiveness of topical heparin in burns management among some patients at the Burns Intensive Care Unit (BICU) of the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Patients for this prospective study were burns victims who were transported to the Accident and Emergency Center of KATH. Complete clerking of the patients and related information were taken. Six patients with ages ranging from 5-35 years, TBSA 5-42% and a combination of 2° and 3° burns were enrolled in the case study. Anatomical locations of the burns included: face, neck, trunk and limbs. Using topical heparin produced smooth skin in two patients: Patients 3 and 5 who reported on Post-burn Day 85 and 116 at the BICU. Five out of the six patients assessed the degree of pain; before treatment with heparin, all five patients stated they were experiencing severe pains, however, three (60.0%) of the patients stated they experienced no pain at all while two (40.0%) were experiencing mild pain after topical heparin application. Heparin was observed to be very effective in the management of burn injuries in the patients studied. It was effective in reduction of pain and prevention of scars and contractures. However, due to the small number of patients and lack of control for the wound healing, a firm recommendation for the use of heparin therapy in burns cannot be made and further studies would be required to establish its use especially in the African population.
Agbenorku, Pius; Fugar, Setri; Akpaloo, Joseph; Hoyte-Williams, Paa E; Alhassan, Zainab; Agyei, Fareeda
Conventional therapy for burns has always produced a nightmarish illness for patients. The lack of the ability to prevent contractures often produces dysfunctional limbs and the ugly scars resulting from severe burns are an ongoing reminder of this lengthy painful illness. This study is to determine the effectiveness of topical heparin in burns management among some patients at the Burns Intensive Care Unit (BICU) of the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Patients for this prospective study were burns victims who were transported to the Accident and Emergency Center of KATH. Complete clerking of the patients and related information were taken. Six patients with ages ranging from 5-35 years, TBSA 5-42% and a combination of 2° and 3° burns were enrolled in the case study. Anatomical locations of the burns included: face, neck, trunk and limbs. Using topical heparin produced smooth skin in two patients: Patients 3 and 5 who reported on Post-burn Day 85 and 116 at the BICU. Five out of the six patients assessed the degree of pain; before treatment with heparin, all five patients stated they were experiencing severe pains, however, three (60.0%) of the patients stated they experienced no pain at all while two (40.0%) were experiencing mild pain after topical heparin application. Heparin was observed to be very effective in the management of burn injuries in the patients studied. It was effective in reduction of pain and prevention of scars and contractures. However, due to the small number of patients and lack of control for the wound healing, a firm recommendation for the use of heparin therapy in burns cannot be made and further studies would be required to establish its use especially in the African population. PMID:23386983
Agbenorku, Pius; Fugar, Setri; Akpaloo, Joseph; Hoyte-Williams, Paa E; Alhassan, Zainab; Agyei, Fareeda
Before Radovan introduced skin expansion, burn sequelae were treated with skin grafts, local or distant flap, with an high morbidity on the donor site. Actually this technique is well known and standardized procedure that allows to obtain local flaps with the same characteristics in colour, texture, hair and sensitivity of the normal skin. The authors analyze their experience in the treatment of burn sequelae from 1985 to 1995. During this period, 157 patients underwent surgery to correct burn scars and contracture, utilizing 262 skin expanders. The implants were positioned on the fascial layer; antibiotic and drainage were routinely used. The inflation of the expander began 2 weeks after surgery, and hyperexpansion was the rule, when possible. Only in 6.4% (10 patients) expansion failed, while in the remaining cases good partial (in patients with too large scars) or total results were achieved. Complication rate in skin expansion is high. In this series complication occurred in 73 of 262 expansion, but 43 were easily solved. So only in 30 expansions the final outcome was influenced by complication, with higher incidence in neck and in lower extremities. Results were generally satisfactory, with an improvement of scars and minimal donor site morbidity. With a careful selection of the patients, skin expansion offers a good solution for burn sequelae, complications can be reduced and successfull results achieved. PMID:9037793
Governa, M; Bonolani, A; Beghini, D; Barisoni, D
Congenital contractural arachnodactyly (CCA) is an autosomal dominant disorder akin to, but usually less severe than, Marfan syndrome. The clinical features are marfanoid habitus, arachnodactyly, crumpled ears, camptodactyly of the fingers and adducted thumbs, mild contractures of the elbows, knees, and hips, and mild muscle hypoplasia especially of the calf muscles. Many patients have kyphoscoliosis and mitral valve prolapse and,
This article summarizes methods of repair of massive and deep wounds, elucidates how to improve wound healing quality and avoid scar deformity after deep burn. A part of denatured dermis (non-necrotic) in deep partial-thickness burn, "mixed degree" burn, even in full-thickness burn wounds before forming eschar can be preserved and covered with autologous skin, thereby to avoid secondary damage to the structure of subcutaneous tissue and the junction of dermis-adipose, thus to result in good functions, appearance, and survival rate. After skin grafting, wound healing quality and appearance are improved, joint function and elasticity of skin are enhanced, the degree of scar contracture is relieved due to preservation of normal adipose tissue after escharectomy. The study of composite artificial skin will be actively developed in the future. Tissue-engineering skin and stem cells can be successfully used in patients with deep burns for scarless healing with restoration of physiological functions in a short period. PMID:19588751
Pediatric upper extremity burns are common. Though current American Burn Association guidelines recommend burn unit referral for burns involving the hands or major joints, many minor injuries are treated in the emergency department (ED) or outpatient setting. Despite the large number of burn patients managed by primary care providers, no large studies have been performed to assess effectiveness. A retrospective 5-year review of the epidemiology and outcomes associated with pediatric upper extremity burns treated at an urban ED was performed. Two hundred sixty-nine patients were identified. The mechanism of burn, percentage of total body surface area (%TBSA) affected, plastic surgery consultations (for wound management recommendations and additional treatment), complications, and surgical interventions were examined. Mechanisms of burn included direct contact (47%), scald (29%), flame (12%), electrical (10%), and friction or chemical (1.5%). Fifty percent of patients suffered from burns over less than 1% TBSA; close to 95% had burns on less than 5% TBSA. Seventy-five percent of patients had second-degree burns, 21% had first-degree burns, and 2% had third-degree burns. Forty patients (15%) had a plastic surgery consult. Seven patients (3%) required skin grafting. Complications occurred in five (2%) patients and included two cases of hypertrophic scarring; two patients with flexor contractures, one case of compartment syndrome requiring fasciotomy, and one late infection. These results suggest that although significant burns are usually cared for in specialized burn centers, the majority of childhood burns to the upper extremity are relatively minor and often treated in the primary care setting. Most patients had small areas of injury and healed without complications. Contact burns are an ever-increasing proportion of childhood burns and should be seemingly preventable. Education to parents and primary care physicians should be reemphasized. It appears that minor upper extremity burns treated by our urban ED staff are handled appropriately and result in favorable outcomes. PMID:18182901
Ewings, Ember Lee; Pollack, Jonathan
Summary Chemical burns represent a major challenge for reconstructive surgeons. They are caused by exposure to acids, alkalis or other corrosive substances which result in various degrees of injury. This report highlights the challenges faced in managing such patients in a Nigerian teaching hospital. The medical records of seven patients (four females and three males) treated for chemical burns injury from January 2001 to December 2010 were retrospectively reviewed. All patients were younger than 30, with a mean age of 23.3. Most of them (85.7%) had sustained full thickness burns ranging from 8% to 33% of their body surface area. All cases were result of assaults. The male to female ratio was 1:1.3, and the average duration of hospital stay was 7.5 months. The face was affected in all patients. Patients presented with multiple deformities, like ectropion of eyelids, keratopathies, blindness, nasal deformities, microstomia, loss or deformities of the pinna, mentosternal contractures, and severe scarring of the face. Twenty-nine surgical procedures were performed, which included nasal and lip reconstruction, ectropion release, commissuroplasty, contracture release, and wound resurfacing. Management of chemical burns, especially in a developing country lacking specialised burn centres with appropriate facilities, is challenging. Prevention through public awareness campaigns, legislation for control of corrosive substances, and severe punishment for perpetrators of assaults using these substances will go a long way in reducing the incidence of chemical burns.
Tahir, C.; Ibrahim, B.M.; Terna-Yawe, E.H.
Tissue scarring due to abnormal matrix remodeling is an important cause of organ failure, which is a leading cause of morbidity\\u000a and mortality. Current studies have fo cused on determination of the molecular basis of controlled wound healing and uncontrolled\\u000a tissue scarring. Scarless repair is a unique feature of fetal wounds in early gestation. Our understanding of the molecular\\u000a basis
Mohammed S. Razzaque; Moussa El-Hallak; Abdallah Azouz; Takashi Taguchi
... fluids are needed to maintain blood pressure. Grafting with natural or artificial materials speeds the post-burn healing process. What is skin grafting? There are two types of skin grafts. An autologous skin graft transfers skin from one part of the body to another while an allograft ...
The incidence of Dupuytren's contracture in a polyvinyl chloride (PVC) manufacturing plant, where a great deal of bagging and packing took place by hand, was higher than in another plant in which there was no bagging or packing. The incidence in the packing plant was double that found in an earlier survey by Early at Crewe Locomotive Works of 4801 individuals, most of whom were manual workers. The implication is that the nature of the work of bagging and packing in our PVC compounding plant may have triggered Dupuytren's contracture.
There are approximately 10,000 pediatric burn survivors in the United States each year, many of whom will present for reconstructive surgery after severe burns in the head and neck (1). These recovered burn victims, who are beyond the acute phase of injury, often have significant scarring and contractures in the face, mouth, nares, neck, and chest, which can make airway management challenging and potentially lead to a 'cannot intubate, cannot ventilate' scenario (2). Although numerous cases have been presented in the literature on this topic (3-17), there are no comprehensive review articles on the unique challenges of airway management in the recovered pediatric burn patient with distorted airway anatomy. This article aims to provide a comprehensive review of airway management in such patients, focusing on challenges encountered during mask ventilation and tracheal intubation, as well as the role of surgical release of neck contractures to facilitate tracheal intubation. Lessons learned from all reported cases identified in a thorough literature search are incorporated into this review. PMID:22260458
Caruso, Thomas J; Janik, Luke S; Fuzaylov, Gennadiy
Aim: To determine the types of functional disabilities in adult and paediatric burns survivors, with specific emphasis on potential risk and socio-economic factors of burn disabilities present in Ghana. Patients and Methods: The descriptive study was carried out in Komfo Anokye Teaching Hospital, Kumasi, Ghana from May 2011 to April 2012. Burn survivors who came for follow-up visits after been discharged home and had functional disability were the participants of the study. They were physically examined and interviewed using a pre-tested questionnaire after their informed consent/or that of their parents (in the cases of paediatrics burns survivors) was sought. Results: A total of 70 participants consented for the study. Their ages ranged from 8/12 – 78 years, with a mean age of 12±1.7 years. Majority (60.0%, N=42) of the participants had third degree burns. The nature of disabilities of participants were mostly scar contractures (42.9%, N=30) of which 36.7% (N=11) had impeded arm elevation; 23.3% (N=7) could not fold the palm or move the digits. From the multiple regression analysis risk factors for burn victim to have disability were paediatric age (OR=11.1, P=0.043), third degree of burn (OR=6.2, P=0.001) and anatomical part affected (OR=18.3, P=0.031). Socio-economic factors that affected burn disability victims were nuclear family compensation (OR=4.2, P=0.021), community mockery/stigmatization (OR=0.1, P=0.052) and caretakers time and finance (OR=5.2, P=0.033). Conclusion: The commonest functional disabilities recorded were scar contractions of the axilla region which had impeded the ability of the patients to lift the arm. Risk factors for burns disability included childhood age, third degree of burn incurred and anatomical part affected. Social factors influencing the lives of burn survivors with disability were good family and negative community interactions. Significant economical factors recorded were caretakers’ time and financial constrains.
There are two types of excessive scarring, keloid and hypertrophic scar. Contrary to hypertrophic scars, keloids do not regress with time, are difficult to revise surgically, and do not provoke scar contractures. These two lesions require different therapeutic approaches but are often confused because of an apparent lack of morphological differences. We have investigated the collagen organization and the possible presence of alpha-smooth muscle (SM) actin-expressing myofibroblasts in these conditions. Keloids contain large, thick collagen fibers composed of numerous fibrils closely packed together. In contrast hypertrophic scars exhibit modular structures in which fibroblastic cells, small vessels, and fine, randomly organized collagen fibers are present. We confirm that such nodular structures are always present in hypertrophic scar and rarely in keloid. Furthermore, only nodules of hypertrophic scars contain alpha-SM actin-expressing myofibroblasts. Electron microscopic examination supports the above-mentioned differences in collagen organization and in fibroblastic features and shows the presence of an amorphous extracellular material surrounding fibroblastic cells in keloid. The presence in hypertrophic scar myofibroblasts of alpha-SM actin, the actin isoform typical of vascular SM cells, may represent an important element in the pathogenesis of contraction. Interestingly, when placed in culture fibroblasts from hypertrophic scars and keloid express similar amounts of alpha-SM actin, suggesting that local microenvironmental factors influence in vivo the expression of this protein. Thus several morphological and immunohistochemical differences exist between hypertrophic scar and keloid that are useful for the biological and pathological characterization of the two lesions. PMID:8030742
Ehrlich, H P; Desmoulière, A; Diegelmann, R F; Cohen, I K; Compton, C C; Garner, W L; Kapanci, Y; Gabbiani, G
Dynamic splinting for the burned hand is used worldwide. We previously presented a home hand therapy program. This program included a series of dynamic splints made by the occupational therapist for daily use by the patient. The "supersplint" evolved from the need to reduce the time required to manufacture the splints for the home therapy program; it also reduced patient-therapist sessions in the occupational therapy unit. The supersplint provides active-resistive movements of the fingers and thumb. As range of motion progresses, resistance can be increased to strengthen muscles and tendons. The supersplint provides tendon gliding, helps control edema, prevents muscle disuse, prevents skin and capsular contracture, minimizes complications, and helps prevent deformities. The patient uses the supersplint daily as part of an occupational therapy program that includes activities of daily living, prevention of shoulder hand syndrome, and scar therapy (including pressure garments). PMID:10661542
Van Straten, O; Sagi, A
Upper extremity deformity of ischemic contracture usually includes elbow flexion, forearm pronation, wrist flexion, thumb flexion and adduction, digital metacarpophalangeal joint extension, and interphalangeal joint flexion. Treatment of mild contractures consists of either nonoperative management with a comprehensive rehabilitation program (to increase range of motion and strenght) or operative management consisting of infarct excision or tendon lengthening. Treatment of moderate-to-severe contractures consists of release of secondary nerve compression, treatment of contractures (with tendon lengthening or recession), tendon or free-tissue transfers to restore lost function, and/or salvage procedures for the severely contracted or neglected extremity. PMID:9742427
Botte, M J; Keenan, M A; Gelberman, R H
The artificial dermis Integra (Ethicon, Johnson & Johnson Medical, Norderstedt, Germany) is widely used in the treatment of excessive burn injuries. It is also used in reconstructive surgery when large soft-tissue defects could not be covered with local or free flaps. In this article a 25-year old patient who presented with an early childhood burn of the trunk and lower extremity was treated with Integra in combination with the vacuum assisted closure (V.A.C., KCI, Texas, U.S.A.) and split thickness skin grafting. The combination of the artificial dermal substitute with negative pressure therapy has lead to a complete healing of Integra and the skin graft. During the whole treatment sterile wound conditions were present and time-consuming dressing changes could be prevented. Hospital stay was shortened because the patient could be treated as an outpatient with an ambulant vacuum assisted closure device. PMID:19523890
Leffler, M; Horch, R E; Dragu, A; Bach, A D
Context: Severe post burns contracture in children not only leads to functional impairment but also has profound psychological impact on the child. Untreated neck contractures have been shown to inhibit mandibular growth. Skin grafting in children has a higher rate of recurrence and in these cases a thin pliable flap seems to provide a durable solution. Aim: To study the feasibility of using primarily thinned free groin flap in the treatment of recurrent neck contractures in children. Materials and Methods: Five patients, in the age group of 5–10 years, with recurrent neck contractures and operated between 2005 and 2008 were included in this study. The sternomental distance, lateral flexion angle and cervicomental angle were measured preoperatively, postoperatively and during the subsequent follow-up visits. The patients were followed up for a period between 1 and 3 years with a mean of 29 months. Results: All the flaps survived. The cervicomental angle improved significantly to 90–105°, the lateral flexion angle improved to 35–45° and the sternomental distance increased considerably. Conclusions: Recurrent post burns contracture of the neck in children causes not only functional and aesthetic impairment but also psychological problems. A free microthinned groin flap provides a very attractive solution for this problem and should be seen as an effective alternative in recurrent cases.
Ghosh, Abhishek; Jayakumar, R.
Fifteen patients with erythematous/hypertrophic scars and eleven patients with post- inflammatory brown hyperpigmentation of scars were treated with flashlamp pump pulsed-dye lasers. The red scars were treated with a wavelength of 585 nm and a pulse width of 450 msec. The brown scars were treated with a wavelength of 510 nm and a pulse width of 300 nsec. The erythematous scars improved an average of 77% after 1.8 treatments, and 46% of these scars had complete resolution of the erythema. The hyperpigmented scars had an average improvement of 80% after 1.5 treatments, and 45% of these patients had complete resolution of the hyperpigmentation. An unexpected benefit of treatment of these scars was softening and flattening of the hypertrophic scar tissue and normalization of the surface of the scar. Repeated treatments were noted to result in cumulative and progressive improvement in all aspects of these scars.
Fitzpatrick, Richard E.
Aggressive management of severe burns minimizes contractures and helps to maintain muscle tone, joint function and psychological well-being. The positioning, activity and exercise programs, splinting and bandaging, and skin care of burned children carried out by the burns team at the Hospital for Sick Children, Toronto is outlined.
Birch, J. R.; Eakins, B.; Gosen, J.; Green, S.; Morton, M.
The aim of this study was to explore the clinical value of the porcine acellular dermal xenograft (ADX) in combination with autologous split-thickness skin and pure autologous split-thickness skin grafting applied in deep full-thickness burns and scar wounds. A total of 30 patients with deep burns were randomly divided into experimental and control groups following escharectomy. The patients were separately treated with porcine acellular dermal xenograft (ADX) in combination with autologous split-thickness skin and pure autologous split-thickness skin graft. The wound healing was observed routinely and the scores were evaluated using Vancouver scar scale at different times following transplant surgery. The samples of cograft regions and the control group (pure transplant split-thickness skin autograft) were observed using light microscopy and electron microscopy, and the follow-up results were recorded. No conspicuous rejections on the cograft wound surface were observed. Compared with the control group, the cograft wounds were smooth, presented no scar contracture and exhibited good skin elasticity and recovery of the joint function. The cografted skin combined well and displayed a clear and continuous basal membrane, as well as gradually combined skin structure, a mature stratum corneum, downward extended rete pegs, a mainly uniform dermal collagen fiber structure, regular alignment, and fewer blood capillaries. Clear desmosome cograft regions were identified among heckle cells, as well as a clear and continuous basal membrane. The cografted skin of the combined split-thickness autograft and the acellular heterologous (porcine) dermal matrix showed an improved shape and functional recovery compared with the pure split-thickness skin autograft. The combination of the meshed ADX and the split-thickness skin autograft applied in deep full-thickness burns and scar wounds may induce tissue regeneration via dermis aiming. This method also has superior shape and functional recovery, and has an extensive clinical application value.
CHEN, XIAODONG; FENG, XIANGSHENG; XIE, JULIN; RUAN, SHUBIN; LIN, YAN; LIN, ZEPENG; SHEN, RUI; ZHANG, FENGGANG
One third of patients with significant burn injuries are children who are injured in what are nearly always preventable incidents. These extremely painful and often scarring bunts are enormous stressors to patients and their families. Children are easily devastated by the burst injury and are often less able to respond to it than au adult. Pediatric burn injury provides multiple
Gary F. Purdue; John L. Hunt; Agnes M. Burris
Objective: Some of the most difficult problems to solve in a postburn breast are the correction of the breast mound deficiency, contour, and projection deformity, which are often associated with an anterior trunk scar. The aim of this study was to describe our experiences of postburn breast reconstruction by the island latissimus dorsi musculocutaneous flap (LDMCF). Method: Operative procedures were planned after measuring the volume, dimensions, sternal notch-to-nipple distance, deviation, asymmetry, contour, and projection. Scar contracture release was carried out and complete muscle elevation was performed in all patients. The size of the skin paddle depended on the envelope deficiency. Afterward, LDMCF was transferred by a subcutaneous tunneling, and the muscle was sutured in retroglandular, inferomedial, and inferolateral ways to shape the inframammary fold (IMF) contour, breast mound, and projection. The skin of the flap was trimmed to match the envelope deficiency. Result: A total of 9 burned patients (11 breasts), who had burnt anterior trunks due to scalds and flame, entered the study. They were reconstructed by LDMCF. The patients achieved breast contour (re-creating the IMF), projection, and breast mound increase. The means of breast mound and projection increase were about 140 mL and 2.5 cm, respectively. Conclusions: This study demonstrates that the method used for reconstructing the burned breast depends on the patient's clinical presentation. For the patients with anterior trunk scar who have breast mound deficiency, IMF, and projection deformity, LDMCF is one of the best options of reconstruction.
Mousavizadeh, Seyed Mehdi; Motamed, Sadrollah; Hosseini, Seyed Nejat; Yavari, Parvin
The concentrations of wave functions about classical periodic orbits, or quantum scars, are a fundamental phenomenon in physics. An open question is whether scarring can occur in relativistic quantum systems. To address this question, we investigate confinements made of graphene whose classical dynamics are chaotic and find unequivocal evidence of relativistic quantum scars. The scarred states can lead to strong conductance fluctuations in the corresponding open quantum dots via the mechanism of resonant transmission.
Huang, Liang [Department of Electrical Engineering, Arizona State University, Tempe, Arizona 85287 (United States); Lai Yingcheng [Department of Electrical Engineering, Arizona State University, Tempe, Arizona 85287 (United States); Department of Physics, Arizona State University, Tempe, Arizona 85287 (United States); Ferry, David K.; Goodnick, Stephen M. [Department of Electrical Engineering, Arizona State University, Tempe, Arizona 85287 (United States); Department of Physics, Arizona State University, Tempe, Arizona 85287 (United States); Center for Solid State Electronics Research, Arizona State University, Tempe, Arizona 85287 (United States); Akis, Richard [Department of Electrical Engineering, Arizona State University, Tempe, Arizona 85287 (United States); Center for Solid State Electronics Research, Arizona State University, Tempe, Arizona 85287 (United States)
Objective Contractures are a major clinical issue for patients with muscular dystrophies. However, it is unknown whether contractures are present in the widely used mdx mouse model of Duchenne muscular dystrophy. Therefore, the objectives of this study were to develop methods to measure muscle contractures in mice, to determine whether plantarflexion contractures are present in mdx mice, and to analyze the composition of the major muscles involved. Design Hindlimbs of eight wild type and six mdx mice were assessed every 2 wks during the course of a 12-wk study. Assessments included range of motion and in vivo torques about the ankle. At the end of the study, mice were euthanized, and muscles were analyzed for composition. Results The mdx mice had ~10 degrees less dorsiflexion, increased passive torque moving the ankle into dorsiflexion, and an increased passive-to-active torque ratio relative to wild type mice. Gastrocnemius muscle composition alterations included increased wet mass, decreased protein content, and increased collagen. Conclusions The results indicate that mdx mice have plantarflexion contractures similar to those seen in children with Duchenne muscular dystrophy. In future studies, these measures can be used to assess strategies to slow the progression of contractures that occur with muscular dystrophies.
Garlich, Michael W.; Baltgalvis, Kristen A.; Call, Jarrod A.; Dorsey, Lisa L.; Lowe, Dawn A.
Keloids and hypertrophic scars are thick, raised dermal scars, caused by derailing of the normal scarring process. Extensive research on such abnormal scarring has been done; however, these being refractory disorders specific to humans, it has been difficult to establish a universal animal model. A wide variety of animal models have been used. These include the athymic mouse, rats, rabbits, and pigs. Although these models have provided valuable insight into abnormal scarring, there is currently still no ideal model. This paper reviews the models that have been developed.
Seo, Bommie F.; Lee, Jun Yong; Jung, Sung-No
Summary A 6-yr-old boy was the victim of a burns accident in a public bathhouse. The burns involved the face, neck, upper and lower extremities, anterior and posterior trunk, and both buttocks, covering 72% of the total body surface area (TBSA). The lesions in the lower extremities and parts of the right upper extremity were deep partial-thickness, comprising 40% TBSA. On day 5 post-burn, the lesions in both lower extremities were excised to the extent of the fascia under general anaesthesia. Meshed J1 Jayya Acellular Dermis®, a kind of acellular allodermal (ADM) matrix, was then placed on the left knee joint. The right knee joint served as control. The wounds in both lower extremities were then overlaid with microskin autografting. At 19 days post-application, the lesions in both lower extremities had almost completely resurfaced. Follow-up at six months revealed well-healed and stable skin of acellular ADM and microskin autografts on the left knee. However, the skin of the right knee was unstable and there was a chronic residual ulcer. Both legs showed some significant hypertrophic scars. The left knee joint (acellular ADM grafted site) showed mild contractures, while the right knee joint developed a significant contracture. The "skin" of the co-graft covered site appeared thicker and more elastic. The movement range of the left knee joint was much larger than that of the right knee joint. These results suggest that co-graft of acellular dermal matrix and autogenous microskin may be an effective way to repair this functional site in children with extensive burns and to improve the functional and cosmetic results.
Chen, X.L.; Xia, Z.F.; Fang, L.S.; Wang, Y.J.; Wang, C.H.
Hypertrophic scars (HTSs) occur in 30 to 72% patients after thermal injury. Risk factors include skin color, female sex, young age, burn site, and burn severity. Recent correlations between genetic variations and clinical conditions suggest that single-nucleotide polymorphisms (SNPs) may be associated with HTS formation. The authors hypothesized that an SNP in the p27 gene (rs36228499) previously associated with decreased restenosis after coronary stenting would be associated with lower Vancouver Scar Scale (VSS) measurements and decreased itching. Patient and injury characteristics were collected from adults with thermal burns. VSS scores were calculated at 4 to 9 months after injury. Genotyping was performed using real-time polymerase chain reaction. Logistic regression was used to determine risk factors for HTS as measured by a VSS score >7. Three hundred subjects had a median age of 39 years (range, 18-91); 69% were male and median burn size was 7% TBSA (range, 0.25-80). Consistent with literature, the p27 variant SNP had an allele frequency of 40%, but was not associated with reduced HTS formation or lower itch scores in any genetic model. HTS formation was associated with American Indian/Alaskan Native race (odds ratio [OR], 12.2; P = .02), facial burns (OR, 9.4; P = .04), and burn size ?20% TBSA (OR, 1.99; P = .03). Although the p27 SNP may protect against vascular fibroproliferation, the effect cannot be generalized to cutaneous scars. This study suggests that American Indian/Alaskan Native race, facial burns, and higher %TBSA are independent risk factors for HTS. The American Indian/Alaskan Native association suggests that there are potentially yet-to-be-identified genetic variants. PMID:23966119
Thompson, Callie M; Hocking, Anne M; Honari, Shari; Muffley, Lara A; Ga, Maricar; Gibran, Nicole S
As plastic surgeons, it has always been our goal to reduce the scarring associated with facial plastic surgeries. These scars generally occur on the scalp and in both the pre- and retroauricular areas. In 194 of our patients who underwent rhytidoplasties, we successfully eliminated these retroauricular and preauricular scars. To achieve these results, we did not make periauricular incisions; instead, we made a superior incision, a subcutaneous dissection, and used various surgical maneuvers such as subdermal plication and structural grafting. By utilizing this facelift technique, we were able to eliminate the appearance of periauricular scars associated with facial plastic surgery, reduce complications, achieve natural-looking results, and increase patient satisfaction. PMID:22083409
Posttraumatic soft-tissue injuries of the face are often the most lasting sequelae of facial trauma. The disfigurement of posttraumatic scarring lies in both their physical deformity and psychosocial ramifications. This review outlines a variety of techniques to improve facial scars and limit their lasting effects. PMID:24138743
Ardeshirpour, Farhad; Shaye, David A; Hilger, Peter A
Scar management has always been important but never as much as today. People are now more aware of their scars, given the hype in the media about looking good. They are more likely than ever to seek treatment for scars from the cosmetic point of view. But scars can be problematic, they can itch and be uncomfortable and painful, they can be disfiguring and aesthetically unpleasant, and may cause sleep disturbance, anxiety, depression and disruption of daily activities. If they lay over the bone joint they can limit its function, so we should not always look at scars from the cosmetic point of view. This article aims to provide a physiological overview of wound repair, describing the options of therapy. PMID:20654000
Edriss, A S; Mesták, J
Reconstruction after post-burn scarring remains a challenge. It is especially true in the severely burned patient, who normally presents with a paucity of donor sites. Healed skin from areas that had been burned and skin from grafted areas (termed as previously burned skin) have been occasionally used as flaps, but their safety is still in debate. We studied all patients
J. P Barret; D. N Herndon; R. L McCauley
The etiology of hypertrophic scarring, a pathological end point of wound healing, is unknown. The scars most commonly occur when epithelialization has been delayed during, for example, the healing of deep dermal burn wounds. Hypertrophic scars are conventionally described as a dermal pathology in which the epidermis has only a passive role. In this study, the expression of keratin intermediate filament proteins and filaggrin has been investigated in the epidermis of hypertrophic scars and site-matched controls from the same patients. Hypertrophic scar epidermis was found to express the hyperproliferative keratins K6 and K16 in interfollicular epidermis in association with K17 and precocious expression of filaggrin. K16 mRNA was localized by in situ hybridization using a highly specific cRNA probe. In contrast to the immunohistochemical location of K16 protein, the K16 mRNA was found to be expressed in the basal cell layer of normal skin. In hypertrophic scars the mRNA distribution corroborated the abnormal K16 protein distribution. These results suggest the keratinocytes in hypertrophic scar epidermis have entered an alternative differentiation pathway and are expressing an activated phenotype. Activated keratinocytes are a feature of the early stages of wound healing producing growth factors that influence fibroblasts, endothelial cells, and the inflammatory response. We propose that cellular mechanisms in the pathogenesis of hypertrophic scarring are more complex than isolated dermal phenomena. The persistence of activated keratinocytes in hypertrophic scar epidermis implicates abnormal epidermal-mesenchymal interactions. Images Figure 1 Figure 3
Machesney, M.; Tidman, N.; Waseem, A.; Kirby, L.; Leigh, I.
The Smoke, Clouds, and Radiation-Brazil (SCAR-B) field project took place in the Brazilian Amazon and cerrado regions in August-September 1995 as a collaboration between Brazilian and American scientists. SCAR-B, a comprehensive experiment to study biomass burning, emphasized measurements of surface biomass, fires, smoke aerosol and trace gases, clouds, and radiation, their climatic effects, and remote sensing from aircraft and satellites.
Y. J. Kaufman; P. V. Hobbs; V. W. J. H. Kirchhoff; P. Artaxo; L. A. Remer; B. N. Holben; M. D. King; D. E. Ward; E. M. Prins; K. M. Longo; L. F. Mattos; C. A. Nobre; J. D. Spinhirne; Q. Ji; A. M. Thompson; J. F. Gleason; S. A. Christopher; S.-C. Tsay
Background Keloids and hypertrophic scars are extremely disturbing to patients, both physically and psychologically. This study prospectively\\u000a assessed the safety and efficacy of intense pulsed light (IPL) on scars originating from burns, trauma, surgery, and acne.\\u000a \\u000a \\u000a \\u000a Methods Hypertrophic scars in 109 patients, originating from surgical incisions (n = 55), traumatic cuts (traffic accidents) (n = 24), acne scars (n = 6), keloids (n = 5), and burns (n = 19), were treated
O. Onur Erol; Ali Gurlek; Galip Agaoglu; Ela Topcuoglu; Hayat Oz
Axillary burns and contractures are physically debilitating. Early splinting and patient compliance is crucial to maximise functional outcomes. Traditional treatment of axillary contractures involves fabrication of thermoplastic aeroplane splints. However, thermoplastic splints can be time consuming to fabricate, heavy, uncomfortable and difficult to don by patients and family. Due to these problems a modified high-density foam (HDF) aeroplane splint was
Gregory A. Chown
Congenital Volkmann ischemic contracture is a very rare condition in which a neonate presents skin, muscular and nerve lesions due to increased intracompartment pressure and subsequent ischemia, probably due to extrinsic intrauterine compression. In this age group, there are only about 50 reported cases and a specific cause is unknown. The authors describe the case of a newborn who presented with bullous and ulcerated skin lesions and nerve palsy of his forearm at birth, evolving to subcutaneous and muscular necrosis and contracture. Two surgeries were performed and the baby began a daily physiotherapy program that resulted in aesthetical improvement and recovery of his hand and forearm mobility. Early recognition of this rare entity and subsequent emergency fasciotomy are the best ways to improve prognosis.
Rios, Marta; Ribeiro, Cristiana; Soares, Paula; Amorim, Rosa; Osorio, Angelica; Leitao, Banquart; Almeida, Alexandra
Special emphasis is placed on the clinical management of facial scarring because of the profound physical and psychological impact of facial burns. Noninvasive methods of facial scar management include pressure therapy, silicone, massage, and facial exercises. Early implementation of these scar management techniques after a burn injury is typically accepted as standard burn rehabilitation practice, however, little data exist to support this practice. This study evaluated the timing of common noninvasive scar management interventions after facial skin grafting in children and the impact on outcome, as measured by scar assessment and need for facial reconstructive surgery. A retrospective review of 138 patients who underwent excision and grafting of the face and subsequent noninvasive scar management during a 10-year time frame was conducted. Regression analyses were used to show that earlier application of silicone was significantly related to lower Modified Vancouver Scar Scale scores, specifically in the subscales of vascularity and pigmentation. Early use of pressure therapy and implementation of facial exercises were also related to lower Modified Vancouver Scar Scale vascularity scores. No relationship was found between timing of the interventions and facial reconstructive outcome. Early use of silicone, pressure therapy, and exercise may improve scar outcome and accelerate time to scar maturity. PMID:23816994
Parry, Ingrid; Sen, Soman; Palmieri, Tina; Greenhalgh, David
We report the use of anterolateral thigh perforator flap (ALTF) from previously burned skin for reconstruction of burn cervical contracture. At the time of treatment, there are no reports of the use of perforator flaps from previously burned skin. We have used this technique and feel that it might be an option to consider in view of the fact that massively burned patients often have limited donor site availability, despite requiring flap tissue to resurface difficult anatomical regions. PMID:16817259
Das-Gupta, Rana; Bang, Christian
Bleach is a common household product which can cause caustic injuries. Its effects on mucosal tissues and the eye have been well-described in the literature. However, there is little information published regarding the appearance and effect of bleach on a child's skin. We report three children who sustained chemical burns after contact with bleach. All three children sustained accidental bleach burns while at home, and each child had a distinct brown discoloration to the skin from the injury. All three children had treatment and follow-up for their burns. Two of the children sustained more severe burns, which were extensive and required more time to heal. There was also long-term scarring associated with the severe burns. Like most burns, pain control is required until the injury heals. PMID:23545350
Lang, Cathleen; Cox, Matthew
This is a report of the first descriptive analytic study of a group of 183 burn patients, treated in the Burn Unit at the University Hospital of Cartagena, Colombia during the period since January 1985 until December 1990. There is presented experience with the selected group of 24 patients in whom the diagnosis of burn was associated with epilepsy. There is also analysed and described the gravity of the scars sequels, neurological disorders, the complication of the burn and an impact of this problem on the patient, his (her) family and the community. It is very important to report that there was found Neurocisticercosis in 66.6% of the group of burn patients with epilepsy, and it is probably the first risk factor of burn in this group. PMID:9212488
AIM--To analyse patterns of gene expression for peptide regulatory factors in patients with Dupuytren's contracture. METHODS--Tissue samples (palmer fascia) from 12 patients with Dupuytren's contracture and 12 controls were studied using the reverse transcription\\/polymerase chain reaction (RT\\/PCR) technique. RESULTS--Tissue from patients with Dupuytren's contracture expressed a higher percentage of peptide regulatory factors than that of controls: interleukin-1 alpha (83% v
K S Baird; J F Crossan; S H Ralston
Prevention and treatment of capsular contracture after breast augmentation is a controversial and oftentimes vexing problem. While there are traditional methods of addressing this condition, acellular dermal matrix materials offer a new and promising modality that is gaining momentum in the field of plastic surgery. In this article, the author examines the etiology and pathophysiology of capsular contracture and review the existing literature on acellular dermal matrix in breast surgery related to capsular contracture. PMID:21908826
Mofid, M Mark
Endometriosis is a common disorder in females of reproductive age. Surgical scar endometrioma after cesarean section develops in 1-2 % of patients, and usually presents as a tender and painful abdominal wall mass. The diagnosis is suggested by pre or perimenstrual pelvic pain and is often established only by histology. In this retrospective observational cohort study, we reviewed the medical records of five patients with a histopathological diagnosis of scar endometriosis. A scar mass was found on a previous Pfannenstiel incision in four patients and in a median cesarean section in one patient. The mean age at diagnosis (38.6 years, median 38) was older than reported elsewhere. A histological examination of the surgical specimen confirmed the diagnosis of endometriosis in all cases. During the follow-up period (mean 34.6 months), local recurrence (n = 1) and pelvic recurrence (n = 1) were treated surgically. Surgery is the treatment of choice for surgical scar endometriosis. Excision with histologically proven free surgical margins of 1 cm is mandatory to prevent recurrence. As scar endometriosis may be associated with pelvic localization, explorative abdominal laparoscopy may be indicated to exclude the intraperitoneal spread of the disease in symptomatic patients. PMID:23307296
Mistrangelo, Massimiliano; Gilbo, Nicholas; Cassoni, Paola; Micalef, Salvatore; Faletti, Riccardo; Miglietta, Claudio; Brustia, Raffaele; Bonnet, Gisella; Gregori, Gianluca; Morino, Mario
Synopsis Limb contractures are a common impairment in neuromuscular diseases (NMD). They contribute to increased disability due to decreased motor performance, mobility limitations, reduced functional range of motion, loss of function for activities of daily living (ADL), and increased pain. The pathogenesis of contractures is multifactorial. Myopathic conditions are associated with more severe limb contractures in comparison to neuropathic disorders. Although the evidence supporting the efficacy of multiple interventions to improve ROM in NMD in a sustained manner is lacking, there are generally accepted principles with regard to splinting, bracing, stretching, and surgery that help minimize the impact or disability from the contractures.
Skalsky, Andrew J.; McDonald, Craig M.
Limb-girdle muscular dystrophies (LGMDs) is a heterogeneous group of muscular dystrophies that mostly affect the pelvic and shoulder girdle muscle groups. We report here a case of neuromuscular disease associated with Dupuytren's contracture, which has never been described before as cosegregating with an autosomal dominant type of inheritance. Dupuytren's contracture is a common disease, especially in Northern Europe. Comorbid conditions associated with Dupuytren's contracture are repetitive trauma to the hands, diabetes, and seizures, but it has never before been associated with neuromuscular disease. We hypothesize that patients may harbor mutations in genes with functions related to neuromuscular disease and Dupuytren's contracture development.
Lace, Baiba; Inashkina, Inna; Micule, Ieva; Vasiljeva, Inta; Naudina, Maruta Solvita; Jankevics, Eriks
Background Uterine rupture at the site of a previous cesarean scar is an uncommon but catastrophic complication of pregnancy, which is associated with significant maternal and fetal morbidity and mortality. Case Presentation A 30-year old woman at 24th week of gestation and complaint of pain, contractions and spotting was admitted in Royan Institute in Tehran, Iran. She had a past medical history of an EP and a cesarean section delivery, respectively 4 and 2 years before hospitalization. Herniation of an amniotic membrane into the maternal bladder was found on ultrasound examination. Conclusion Risk factors of cesarean scar rupture should be considered in women undergoing subsequent pregnancies as they need extra care. Ultrasonography can be used to evaluate women with previous cesarean section to assess the risks of scar rupture during subsequent pregnancies.
Ahmadi, Firoozeh; Siahbazi, Shiva; Akhbari, Farnaz
In man and domestic animals, scarring in the skin after trauma, surgery, burn or sports injury is a major medical problem, often resulting in adverse aesthetics, loss of function, restriction of tissue movement and\\/or growth and adverse psychological effects. Current treatments are empirical, unreliable and unpredictable: there are no prescription drugs for the prevention or treatment of dermal scarring. Skin
Mark W. J. Ferguson; Sharon O'Kane
To evaluate changes in matrix molecules of the joint capsule, the right knees of 24 skeletally mature female NZW rabbits were immobilized while the contralateral limb served as an unoperated control. The immobilization was discontinued at 8 weeks and the rabbits were divided among four groups (n = 6) based on the number of weeks the right knees were remobilized: 0, 8, 16, or 32. Three rabbits (six knees) that did not have operations provided normal control joint capsules. The mRNA levels for collagen types I, II, and III, and MMP-1 and -13 were significantly increased in the joint capsules of the contracture knees in all groups when compared to normal and contralateral limb joint capsules. In contrast, the mRNA levels for TIMP-1, -2, and -3 were decreased in the joint capsules of the contracture knees in all groups when compared to normal and contralateral limb joint capsules. The mRNA levels for lumican and decorin were increased in the joint capsules of the contracture knees in all groups when compared to normal capsules. Many of the changes observed in this animal model are similar to those observed in human joint capsules from posttraumatic elbow contractures, supporting the value of this rabbit model.
Hildebrand, Kevin A.; Zhang, Mei; Hart, David A.
... can be applied to a raised scar. Applying tretinoin (a prescription medication used to treat acne) twice ... you can apply to the scar. Applying both tretinoin and a strong corticosteroid to a keloid seems ...
Background Pirfenidone (PFD), a new antifibrotic and antiinflammatory agent, prevents and resolves fibrous tissue. This study evaluated\\u000a the effect of PFD on adverse events in mammary implants using an animal model. Mammary implantation, the most frequent aesthetic\\u000a surgery, may present several complications after surgery such as swelling, capsule contracture, hardness, and pain.\\u000a \\u000a \\u000a \\u000a Methods Wistar rats underwent submammary implantation with either smooth or
Matias Gancedo; Luis Ruiz-Corro; Adriana Salazar-Montes; Ana Rosa Rincón; Juan Armendáriz-Borunda
The author makes comments about the shortening and loss of elasticity of the oculomotor muscle that remains slack for some time (contracture), by means of a reasoning based on the Hooke s law and on the papers carried out to demonstrate that a muscle that remains relaxed for some time suffers a shortening due to loss of sarcomeres on the longitudinal direction and the increase of the cross-sectional area due to the increase of collagen tissue in the perimysium and the endomysium. PMID:20549056
Souza-Dias, Carlos Ramos de
Objective: Pathologic scarring affects millions of people worldwide. Quantitative and qualitative measurement modalities are needed to effectively evaluate and monitor treatments. Methods: This article reviews the literature on available tools and existent assessment scales used to subjectively and objectively characterize scar. Results: We describe the attributes and deficiencies of each tool and scale and highlight areas where further development is critical. Conclusion: An optimal, universal scar scoring system is needed in order to better characterize, understand and treat pathologic scarring.
Fearmonti, Regina; Bond, Jennifer; Erdmann, Detlev; Levinson, Howard
Burns require psychosocial healing in addition to physical recovery as survivors face challenges such as scarring and altered appearance. An adjunct to interventions provided by social workers and other professionals is peer support from fellow burn survivors. But how do burn survivors view this intervention? This study examined a sample of burn survivors to learn about their views of peer
Karen Badger; David Royse
Twelve patients with severe and recurrent capsular contractures following breast augmentation and reconstruction were improved with polyurethane-covered implants. It still has not been established whether these implants prevent or merely delay the onset of contractures, but some of these patients have been followed for over three years and all 12 were improved.
Dupuytren's contracture is a condition commonly encountered by hand surgeons, although it is rare in the Asian population. Various surgical procedures for Dupuytren's contracture have been reported, and the outcomes vary according to the treatment modalities. We report the treatment results of segmental fasciectomies with multiple transverse incisions for patients with Dupuytren's contracture. The cases of seven patients who underwent multiple segmental fasciectomies with multiple transverse incisions for Dupuytren's contracture from 2006 to 2011 were reviewed retrospectively. Multiple transverse incisions to the severe contracture sites were performed initially, and additional incisions to the metacarpophalangeal (MCP) joints, and the proximal interphalangeal (PIP) joints were performed if necessary. Segmental fasciectomies by removing the fibromatous nodules or cords between the incision lines were performed and the wound margins were approximated. The mean range of motion of the involved MCP joints and PIP joints was fully recovered. During the follow-up periods, there was no evidence of recurrence or progression of disease. Multiple transverse incisions for Dupuytren's contracture are technically challenging, and require a high skill level of hand surgeons. However, we achieved excellent correction of contractures with no associated complications. Therefore, segmental fasciectomies with multiple transverse incisions can be a good treatment option for Dupuytren's contracture.
Lee, Hyunjic; Cho, Sanghun; Jones, Neil F.
A 71-year-old man developed polyarthritis and, subsequently, severe flexion contractures of multiple joints, particularly the joints of the hands. Eighteen months after developing this disease a parailiacal lymph node metastasis of an unknown primary cancer was found. We suggest that this patient's history, dominated by contractures that resembled the ‘palmar fasciitis and polyarthritis syndrome’, should be considered as a paraneoplastic
E. M. W. Eekhoff; P. A. van der Lubbe; F. C. Breedveld
The contractures induced by 20-200 mM [K+]o in single crab muscle fibers were resolved into two components. The first component, consisting of single twitches or brief tetanic contractions, was associated with electrogenic membrane responses. The second occurred after spiking subsided with an amplitude that increased linearly with the [K+]o between 20 and 90 mM. The amplitude and time course of the contractures elicited by a given [K+]o differed markedly between different fibers. Contracture reproducibility of a single fiber was best when 90 mM [K+]o was used. The K-induced contractures were abolished after brief (3 min) exposure of the fibers to a calcium-free solution and were greatly depressed by 8 mM procaine. The data suggest that the contractures require both Ca2+-influx across the sarcolemma and release of Ca2+ stored in the sarcoplasmic reticulum. PMID:6518341
Leal-Cardoso, J H; Suarez-Kurtz, G
Principles to minimize scars include attention to a multitude of intrinsic and extrinsic patient factors preoperatively, operatively, and postoperatively. Preoperatively the goal is to maximize the treatment of patient specific comorbidities and limit the usage of medications that can have negative effects on healing. Operatively, the focus is on proper incisional planning, meticulous surgical technique and hemostasis, judicious use of prophylactic antibiotics, and focus on tensionless closures. Postoperatively, we must maximize the healing environment by keeping the wound well hydrated and closely monitoring and intervening early in high-risk wounds. We also have the responsibility to provide evidence-based recommendations, to the best of our ability, regarding the myriad of over-the-counter products. The field of scar prevention is ever changing and the new frontier focuses on controlling the microenvironment of wounds and altering signaling molecules to promote near scarless healing. PMID:23027213
Gantwerker, Eric Alan; Hom, David B
Hypertrophic scarring is devastating for the patient, however the pathophysiology and treatment remain unknown after decades of research. The process follows deep dermal injury, occurs only on certain body parts, does not occur in the early fetus or in animals, and is a localized event. This suggests that an anatomic structure in human, deep dermis may be involved. The dermis is a matrix perforated by cones containing many structures including skin appendages and fat domes. We hypothesized that studying the cones might reveal a structure related to scarring. We examined tangential wounds from various body parts on human cadavers along with skin histology from various human body parts, the early fetus, partial thickness burns, hypertrophic scars, and two other species-rats and rabbits. We found that the cones may in fact be the structure. They exist where hypertrophic scar occurs-cheek, neck, chest, abdomen, back, buttock, arm, forearm, dorsal hand, thigh, leg, dorsal foot, helix and ear lobe. They do not exist where hypertrophic scar does not occur-scalp, forehead, concha, eyelid, palm, early fetus, and in rat, or rabbit. It also became apparent that the cones have been omitted from most considerations of skin histology. We suggest that the cones need to be studied in relation to hypertrophic scarring and restored to skin diagrams. PMID:11679135
Matsumura, H; Engrav, L H; Gibran, N S; Yang, T M; Grant, J H; Yunusov, M Y; Fang, P; Reichenbach, D D; Heimbach, D M; Isik, F F
These findings are presented which indicate that nerves are not limited simply to relaying electrical signals to the muscles but also exert a direct influence which controls the characteristics of the contracture. Neural control is not dependent on nerve ...
R. Elul R. Miledi E. Stefani
Capsular contracture after breast augmentation is a distressing, troublesome event both for the patient and the surgeon. Fibrosis\\u000a transforms the prosthesis into a hardened sphere, turning the initially satisfactory cosmetic result into a deformed mass.\\u000a Treatment for capsular contracture can be either surgical, consisting of capsulotomy or capsulectomy with implant replacement,\\u000a or pharmacologic, consisting of intracapsular instillation of steroids and
Nicolò Scuderi; Marco Mazzocchi; Paolo Fioramonti; Giovanni Bistoni
Normal motion of the proximal interphalangeal joint requires bony support, intact articular surfaces, unimpeded tendon gliding, and uncompromised integrity of the collateral ligaments and volar plate. Deficiency in any one of these structural requirements can lead to a loss of finger joint motion and decreased hand function. Once finger extension is lost, options include nonsurgical or surgical treatment. Nonsurgical treatment such as splinting or serial casting should be tried before attempting surgical intervention. When severe flexion deformity exists or the vascular status of the finger has been compromised, arthrodesis or amputation should be undertaken instead of procedures to regain motion. Surgical options for regaining motion include external fixators and open surgical release. Although they can lead to improved extension at the proximal interphalangeal joint, external fixators carry a risk of reduced finger flexion and pin site infection. Most clinical series of patients who have undergone surgical release document improvement in flexion contracture between 25 degrees to 30 degrees and a shift of the flexion/extension arc into a more functional range. Close follow-up after surgery is warranted, with frequent physical therapy and splinting. PMID:16959890
Hogan, Christopher J; Nunley, James A
After injury to the adult central nervous system (CNS), injured axons cannot regenerate past the lesion. In this review, we present evidence that this is due to the formation of a glial scar. Chondroitin and keratan sulphate proteoglycans are among the main inhibitory extracellular matrix molecules that are produced by reactive astrocytes in the glial scar, and they are believed
Jared H. Miller; Jerry Silver
A quantum scar is a wave function which displays a high intensity in the region of a classical unstable periodic orbit. Saddle scars are states related to the unstable harmonic motions along the stable manifold of a saddle point of the potential. Using a semiclassical method it is shown that, independently of the overall structure of the potential, the local
R. Vilela Mendes; Grupo de F ´ õsica-Matematica
Cutaneous scarring can cause patients symptoms ranging from the psychological to physical pain. Although the process of normal scarring is well described the ultimate cause of pathological scarring remains unknown. Similarly, exactly how early gestation fetuses can heal scarlessly remains unsolved. These questions are crucial in the search for a preventative or curative antiscarring agent. Such a discovery would be of enormous medical and commercial importance, not least because it may have application in other tissues. In the clinical context the assessment of scars is becoming more sophisticated and new physical, medical and surgical therapies are being introduced. This review aims to summarise some of the recent developments in scarring research for non-specialists and specialists alike.
Baker, Richard; Urso-Baiarda, Fulvio; Linge, Claire; Grobbelaar, Adriaan
Summary Hairdressing-related burns are preventable and therefore each case is one too many. We report a unique case of a 16-yr-old girl who suffered full-thickness chemical and thermal burns to the nape of her neck and superficial burns to the occiput after her hair had been dyed blond and placed under a dryer to accelerate the highlighting procedure. The wound on the nape of the neck required surgical debridement and skin grafting. The grafted area resulted in subsequent scar formation.
Forster, K.; Lingitz, R.; Prattes, G.; Schneider, G.; Sutter, S.; Schintler, M.; Trop, M.
The mechanisms of hypertrophic scar formation are not fully understood. We previously screened the differentially expressed genes of human hypertrophic scar tissue and identified P311 gene as upregulated. As the activities of P311 in human fibroblast function are unknown, we examined the distribution of it and the effects of forced expression or silencing of expression of P311. P311 expression was detected in fibroblast-like cells from the hypertrophic scar of burn injury patients but not in peripheral blood mononuclear cells, bone marrow mesenchymal stem cells, epidermal cells or normal skin dermal cells. Transfection of fibroblasts with P311 gene stimulated the expression of alpha-smooth muscle actin (?-SMA), TGF-?1 and ?1(I) collagen (COL1A1), and enhanced the contraction of fibroblast populated collagen lattices (FPCL). In contrast, interference of fibroblast P311 gene expression decreased the TGF-?1 mRNA expression and reduced the contraction of fibroblasts in FPCL. These results suggest that P311 may be involved in the pathogenesis of hypertrophic scar via induction of a myofibroblastic phenotype and of functions such as TGF-?1 expression. P311 could be a novel target for the control of hypertrophic scar development.
Ma, Bing; Cao, Chuan; He, Weifeng; Yuan, Shunzong; Li, Shirong; Wilkins, John A.; Wu, Jun
Arthrogryposis represents a group of heterogeneous disorders, characterized by contractures of multiple joints at birth. Involvement of the hip is very common (55-90% of patients) ranging from soft tissue contractures to subluxation and dislocation. Isolated contracture of the hip can usually be managed conservatively: compensative mechanisms and contractures of other joints should be evaluated before planning surgery. For unilateral dislocations, open reduction is indicated to provide a level pelvis, even though the risk of stiffness, avascular necrosis and redislocation is significant. Indications for surgical reduction of bilateral dislocations are more controversial: an adequate evaluation of ambulatory potential of the child (muscular weakness, involvement of upper extremities, etc.) and of stiffness of the hips is suggested. An extensive and long-lasting programme of bracing, physiotherapy and multiple surgery may lead to some measure of functional ambulation in most cases, but high need for surgery and considerable risk of complications must be considered. This paper summarizes problems and principles of treatment for hip contractures and dislocations in arthrogryposis and provides a review of the current literature. PMID:22278604
Stilli, Stefano; Antonioli, Diego; Lampasi, Manuele; Donzelli, Onofrio
Facial hypertrophic scarring is certainly not an uncommon event and can lead to significant aesthetic and functional problems.\\u000a Its etiologies can range from thermal burns, facial trauma, infectious diseases, congenital deformities or tumor ablation.\\u000a Many have described the prevention and treatment of hypertrophic scars, all with varying degrees of success. Using a form\\u000a of pressure therapy, the custom fitted transparent
G. Mosiello; S. P. Maggi; P. Smith; M. C. Robson
Sandal is an ancient, primitive heating device that is still in use by both poor and rich people in mountain areas of Middle Asia. Sandal burn injuries are a serious health problem. Characteristics of sandal burns include not only skin injuries of various depths but also injuries to underlying tissues: subcutaneous fat, fasciae, muscles, and even bones. Sandal burns are characterized by such severe deep injuries because of a close contact of the body with live coals or woods. The main goal of this work was to present the most complete information about sandal burns and discuss the most effective methods of treatment for sandal burns. This treatment is used to accelerate the rejection of necrotic tissue, to prepare the wound for early autodermoplastic surgery, to decrease the postburn contractures/deformities, and also to shorten hospital stay for the patients. PMID:15534459
Shakirov, Babur M
Integra dermal matrix (Integra Life Sciences Corp., Plainsboro, NJ) was introduced in 1981, and its use in acute surgical burns is well established. However, Integra also has been found to be useful in the surgical treatment of scars. The Integra neodermis is placed at the time of scar excision and then overgrafted several weeks later with a very thin (6/1000-inch) skin graft. The stabilized matrix appears to resist recurrence better than traditional skin grafts, which have a reported recurrence rate of 59%. Many surgeons have had anecdotal success using Integra for both hypertrophic and keloidal scars. This case series presents several patients who underwent reconstructive surgery with the use of Integra to treat their debilitating scar formation. None of the patients developed significant scar morbidity at the donor site when the skin was harvested for grafting during the second stage of the procedure. All patients had documented success with improved appearance, range of motion, and skin quality. PMID:16679913
Clayman, Mark A; Clayman, Scott M; Mozingo, David W
Objective (s): Scar formation in injured peripheral nerve bed causes several consequences which impede the process of nerve regeneration. Several animal models are used for scar induction in preclinical studies which target prevention and/or suppression of perineural scar. This study evaluates the translational capacity of four of physical injury models to induce scar formation around the sciatic nerve of rat: laceration, crush, mince and burn. Materials and Methods: Functional (Toe out angle), macroscopic, and microscopic evaluations were performed weekly for four weeks and correlation of findings were analyzed. Result: While macroscopic and microscopic findings suggested a well-developed and adhesive fibrosis surrounding the sciatic nerve, functional assessment did not reveal any significant difference between control and experimental groups (P>0.05). Conclusion: Our study suggests that none of the applied animal models reproduce all essential features of clinical perineural scar formation. Therefore, more studies are needed to develop optimal animal models for translating preclinical investigations.
O Zanjani, Leila; Firouzi, Masoumeh; Nabian, Mohammad-Hossein; Nategh, Mohsen; Rahimi-Movaghar, Vafa; S Kamrani, Reza
Burns are the third leading cause of death in childhood and adolescence. For those surviving burn injury, scarring and loss of function can be devastating, in terms of body image and self-esteem, with accompanying depression. Using a wide range of measures and age samples, earlier research explored the impact of demographic, burn-related (age at time of burn, years elapsed since
Deborah Ann Orr
This report examines the localization of time harmonic high frequency modal fields in two dimensional cavities along periodic paths between opposing sides of the cavity. The cases where these orbits lead to unstable localized modes are known as scars. Thi...
J. D. Kotulski K. S. H. Lee L. K. Warne R. E. Jorgensen
. As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating\\u000a line between acceptable and unacceptable aesthetic results. With this in mind, a scar management program has been adopted\\u000a based on the modalities of wound support, hydration, and hastened maturity, all factors gleaned from scientific evidence published\\u000a over the past 25
Alan D. Widgerow; Laurence A. Chait; Rene Stals; Pieter J. Stals
A review of 105 children with urinary tract infection showed an increasing prevalence of grades II-III vesicoureteric reflux with diminishing age. During infancy reflux was almost always severe, and affected boys as often as girls. Radiologically scarred kidneys were drained by refluxing ureters in 98% of cases. The prevalence of scars also rose significantly with increasinglyly severe reflux. Deterioration of existing scars or new scar formation was seen in 15 children; 18 out of 20 affected kidneys (90%) were associated with grade III vesicoureteric reflux. 2 out of 5 children who developed new scars did so after 5 years of age. Because severe reflux may occasionally be seen in the presence of a normal intravenous urogram, and since the finding of grades II-III vesicoureteric reflux is an indication for chemoprophylaxis, we consider cystourethrography essential in children of all ages with recurrent urinary tract infection. In children under 5 years the increased prevalence of both severe reflux and renal scarring are arguments for regarding cystourethrography as a necessary initial investigation. Images Fig. 1 p213-a Fig. 2 Fig. 3 Fig. 4 p216-b
Shah, K J; Robins, D G; White, R H
Of the many topical scar modification treatments available, silicone gel sheeting is the only product shown to be effective for the treatment of hypertrophic scars. Other topical scar treatments are frequently used without evidence of their efficacy. The authors discuss available topical scar treatments and their current role in clinical plastic surgery practice. PMID:19338826
McGrath, Mary H; Chang, David S
Of the many topical scar modification treatments available, silicone gel sheeting is the only product shown to be effective for the treatment of hypertrophic scars. Other topical scar treatments are frequently used without evidence of their efficacy. The authors discuss available topical scar treatments and their current role in clinical plastic surgery practice.
Mary H. McGrath; David S. Chang
Joint contracture, a major complication after casting, usually makes the therapeutic outcome worse by causing a limited range\\u000a of motion and related pain. We developed rat models of wrist contracture with fracture of the radius (group A) and wrist contracture\\u000a without fracture (group B), and investigated whether contracture and fracture changed the characteristics of cervical dorsal\\u000a horn neuronal responses and
Takahiro Ushida; William D. Willis
The occurrence and incidence of acne scarring is different. Lasting for years, acne can cause both physical and psychological scarring. Scarring frequently results from severe inflammatory nodulocystic acne but may also result from more superficial inflamed lesions or from self-manipulation. There are two general types of acne scars: hypertrophic (keloid) scars, and atrophic (icepick, rolling and boxcar) scars. The management of acne scarring includes various types of resurfacing (chemical peels, lasers, lights, cryotherapy), use of dermal fillers, and surgical methods such as dermabrasion, subcision or punch excision. Individual scar characteristics, including color, texture and morphology, determine the treatment choice. Combining treatment methods may provide additional improvement compared with one method alone. It should be noted that none of the currently available treatments can achieve complete resolution of the scar. The best method of preventing or limiting scarring is to treat acne early enough to minimize the extent and duration of inflammation. PMID:20887698
Objective: This study aims at combined surgical therapy options concerning patients with a clinically relevant and long-established capsular contracture following subglandular breast augmentation in a glandular ptotic breast. Methods: This is a review of 23 patients with capsular contracture. Three patients had a revision surgery for capsular contracture and implant dislocation before. The mean implant duration in the case of
Wulf Siggelkow; Antje Lebrecht; Heinz Kölbl; Andre Faridi
Joint contractures which do not respond to conventional physiotherapy can be difficult to treat. Serial plastering has been used effectively but is expensive, inconvenient to the patient and does not permit daily hygiene or clinical inspection. A mechanical device has been developed consisting a hinged orthosis which spans the affected joint to which is attached a gas strut to provide
P. CHARLTON; D. FERGUSON; C. PEACOCK; J. STALLARD
Summary Bethlem myopathy is an early-onset benign autosomal dominant myopathy with contractures caused by mutations in collagen type VI genes. It has been reported that onset occurs in early childhood. We investigated the natural course of Bethlem myopathy in five previously published kindreds and two novel pedigrees, with particular attention to the mode of onset in 23 children and the
G. J. Jobsis; J. M. Boers; P. G. Barth; M. de Visser
Two cats presented with bilateral flexor tendon contracture following onychectomy. This previously unreported complication proved to be painful and debilitating. Deep digital flexor tenectomy successfully resolved the problem. Twelve months after surgery, the first cat remains free of complications. The second cat recovered full limb function, but died of unrelated causes. PMID:15884646
Cooper, Maureen A; Laverty, Peter H; Soiderer, Emily E
Abstract Two cats presented with bilateral flexor tendon contracture following onychectomy. This previously unreported complication proved to be painful and debilitating. Deep digital flexor tenectomy successfully resolved the problem. Twelve months after surgery, the first cat remains free of complications. The second cat recovered full limb function, but died of unrelated causes.
Dupuytren's disease is a relatively rare occurrence in a patient of the black race. The coexistence of a Dupuytren's contracture in a black patient who also presents with severe gouty tophi is described. This is the first reported case in the English literature.
LeFlore, I.; Antoine, G. A.
The skin expansion marks a turning point in the repair of burn sequelae by allowing replace the original tissue with a coating of the same quality or a large full-thickness skin graft. The authors explain the peculiarities of this process in the sequelae of burn: indications, surgical technique, complications. They stressed the difficulties related to the "invisible loss" of skin, the "mandatory deficit" of the expansion, the expansion sub-scarring, the development of the treatment plan, the sustainability of the expansion. PMID:21925783
Mimoun, M; Boccara, D; Chaouat, M
Silicone thermoplastic sheeting has been used successfully in the management of hypertrophic and keloid scars resulting from thermal burn injuries. A technique is described that incorporates silicone thermoplastic sheeting for fabrication of a compression face mask. This technique combines the moldability of thermoplastic splinting materials with the therapeutic surface of silicone, yielding the advantages of both in a one-step process. PMID:10740514
Bradford, B A; Breault, L G; Schneid, T; Englemeier, R L
The seasonally burned cerrados of Brazil are the largest savanna-type ecosystem of South America and their contribution to the global atmospheric nitrous oxide (N20) budget is unknown. Four types of fire-scarred cerrado along a vegetation gradient from gr...
A. D. Nobre P. M. Crill R. C. Harriss
The use of filler for depressed scars has been documented but is rare in the literature. We present a case of a patient treated with hyaluronic acid fillers at the site of a long-standing depressed scar. PMID:22630585
Khan, Farhan; Richards, Kristen; Rashid, Rashid M
The purpose of this study was to establish whether an increase in failed termination of pregnancy is observed among individuals with arthrogryposis (multiple congenital contractures). A total of 2,500 unselected patients with arthrogryposis collected by the author over a 35-year period were reviewed. The cases included referrals, consultations, personal examinations, and correspondence. They were reviewed for clinical features, pregnancy complications, family history, and a history of attempted terminations of the pregnancy. Eleven cases of failed terminations of pregnancy in which the individuals were subsequently born with arthrogryposis were identified. We conclude that infants who survive attempted termination of pregnancy (both surgical and medical) may be at an increased risk to be born with multiple congenital contractures. Careful examination of the tissue and a post-procedure ultrasound will help to assure that the termination has been successful. Those infants surviving attempted termination of pregnancy who have arthrogryposis are also at >50% risk for intellectual disability. PMID:22888032
Hall, Judith G
Intrinsic contracture of the hand may result from trauma, spasticity, ischemia, rheumatologic disorders, or iatrogenic causes. In severe cases, the hand assumes a posture with hyperflexed metacarpophalangeal joints and hyperextended proximal interphalangeal joints as the contracted interossei and lumbrical muscles deform the natural cascade of the fingers. Considerable disability may result because weakness in grip strength, difficulty with grasping larger objects, and troubles with maintenance of hygiene commonly encumber patients. Generally, the diagnosis is made via history and physical examination, but adjunctive imaging, rheumatologic testing, and electromyography may aid in determining the underlying cause or assessing the severity. Nonsurgical management may be appropriate in mild cases and consists of occupational therapy, orthoses, and botulinum toxin injections. The options for surgical management are diverse and dictated by the cause and severity of contracture. PMID:24084432
Tosti, Rick; Thoder, Joseph J; Ilyas, Asif M
Aims: To demonstrate success with immediate split-skin graft application over Matriderm dermal matrix in a difficult neck contracture release. Methods: An aggressive neck contracture release, accompanied by complete platysmectomy, was followed by application of Matriderm, split-skin graft, Mepitel, and vacuum-assisted closure (VAC) dressing. Results: At VAC removal (day 7), graft take was almost complete over the dermal matrix and with minor “touch-up” were complete by day 9 postrepair. Results at 4 months show graft contraction and a marked diminution of the release obtained. The results, however, are still good and the patient is very happy. Conclusion: Immediate grafting over a dermal matrix appears to provide a good solution, with a gentle surgical learning curve, in this difficult postburn scenario. Postrelease contraction is, however, as inevitable as with other techniques.
Greenwood, John E.; Mackie, Ian P.
The purpose of this study was to evaluate range of motion and patient-reported outcome after complete arthroscopic release of post-traumatic elbow contracture. Fourteen consecutive patients who underwent elbow arthroscopy and capsular release were reviewed retrospectively at a minimum follow-up of 1 year. Pain and range of motion were measured. Patient outcome was assessed with the American Shoulder and Elbow Surgeons
Craig M Ball; Matthew Meunier; Leesa M Galatz; Ryan Calfee; Ken Yamaguchi
Abstract Purpose: Contractures are common problems for the elderly with far reaching functional and medical consequences. The aim of this systematic literature review was to give an overview of contracture and to identify potential risk factors associated with contractures. Methods: A systematic literature search with two objectives limited to the last 10 years was performed to identify studies dealing with definition of contracture (objective 1?=?O1) and with risk factors (objective 2?=?O2). Predefined information including age, sample size, study design, setting, condition, joint, definition of contracture, mode of measurement, and whether inter- and/or intra-rater reliability were assessed, as well as risk factors of contracture were extracted. Results: One hundred and sixty one and 25 studies were retrieved. After applying exclusion criteria 47 studies (O1) and 3 studies (O2) remained. Only 9 studies (O1) provided a definition of contracture. In 3 studies (O2) several potential risk factors were identified. Conclusions: In most of the studies it seems that the presence of a contracture is equivalent with the presence of restriction in the range of motion (ROM) of a joint. Very little is known about risk factors for contractures. But it seems that immobility may play a pivotal role in the development of this condition. Implication for Rehabilitation The prevalence of contractures in nursing home residents is estimated at 55% with significant functional and medical consequences. In most studies, which were published in the last 10 years, the presence of a contracture is equivalent with the presence of restriction in the range of motion of a joint. Immobility seems to play a role in the development of contractures. Potential avenues to prevention of contractures and subsequent functional limitations are exercise programmes for and maintenance of mobility of the elderly. PMID:23772994
Offenbächer, M; Sauer, S; Rieß, J; Müller, M; Grill, E; Daubner, A; Randzio, O; Kohls, N; Herold-Majumdar, A
A 58-year-old man who had had three laparotomies for gastric surgery, developed a painful mass in the abdominal wall scar. Radiology confirmed bone formation in the scar. The bone was excised and the wound repaired. Histology confirmed metaplastic mature bone formation. This case draws the attention to the clinical condition of bone formation in midline scars. Clinically, it should be
R A Daoud; M J Watkins; G Brown; N Carr
A little is known about proteoglycan (PG) changes, occuring in the course of scarring of tissues another than skin. The aim of present study was biochemical characterization of glycosaminoglycans (GAGs) and proteoglycans (PGs) of normal and scarred fascia. Samples of normal fascia lata were taken at autopsy from 23 individuals and samples of scarred fascia lata were removed from 23
Ewa Maria Ko?ma; Krystyna Olczyk; Andrzej G?owacki; Rafa? Bobi?ski
BACKGROUND: Splinting as part of the overall post-surgical management of patients after release of Dupuytren's contracture has been widely reported, though there is variation in practice and criteria for using it. The evidence on its effectiveness is sparse, of poor quality and contradictory with studies reporting negative and positive effects. METHODS\\/DESIGN: A multi-centre, pragmatic, randomized, controlled trial is being conducted
Christina Jerosch-Herold; Lee Shepstone; Adrian J Chojnowski; Debbie Larson
In man and domestic animals, scarring in the skin after trauma, surgery, burn or sports injury is a major medical problem, often resulting in adverse aesthetics, loss of function, restriction of tissue movement and/or growth and adverse psychological effects. Current treatments are empirical, unreliable and unpredictable: there are no prescription drugs for the prevention or treatment of dermal scarring. Skin wounds on early mammalian embryos heal perfectly with no scars whereas wounds to adult mammals scar. We investigated the cellular and molecular differences between scar-free healing in embryonic wounds and scar-forming healing in adult wounds. Important differences include the inflammatory response, which in embryonic wounds consists of lower numbers of less differentiated inflammatory cells. This, together with high levels of morphogenetic molecules involved in skin growth and morphogenesis, means that the growth factor profile in a healing embryonic wound is very different from that in an adult wound. Thus, embryonic wounds that heal without a scar have low levels of TGFbeta1 and TGFbeta2, low levels of platelet-derived growth factor and high levels of TGFbeta3. We have experimentally manipulated healing adult wounds in mice, rats and pigs to mimic the scar-free embryonic profile, e.g. neutralizing PDGF, neutralizing TGFbeta1 and TGFbeta2 or adding exogenous TGFbeta3. These experiments result in scar-free wound healing in the adult. Such experiments have allowed the identification of therapeutic targets to which we have developed novel pharmaceutical molecules, which markedly improve or completely prevent scarring during adult wound healing in experimental animals. Some of these new drugs have successfully completed safety and other studies, such that they have entered human clinical trials with approval from the appropriate regulatory authorities. Initial trials involve application of the drug or placebo in a double-blind randomized design, to experimental incision or punch biopsy wounds under the arms of human volunteers. Based on encouraging results from such human volunteer studies, the lead drugs have now entered human patient-based trials e.g. in skin graft donor sites. We consider the evolutionary context of wound healing, scarring and regeneration. We hypothesize that evolutionary pressures have been exerted on intermediate sized, widespread, dirty wounds with considerable tissue damage e.g. bites, bruises and contusions. Modem wounds (e.g. resulting from trauma or surgery) caused by sharp objects and healing in a clean or sterile environment with close tissue apposition are new occurrences, not previously encountered in nature and to which the evolutionary selected wound healing responses are somewhat inappropriate. We also demonstrate that both repair with scarring and regeneration can occur within the same animal, including man, and indeed within the same tissue, thereby suggesting that they share similar mechanisms and regulators. Consequently, by subtly altering the ratio of growth factors present during adult wound healing, we can induce adult wounds to heal perfectly with no scars, with accelerated healing and with no adverse effects, e.g. on wound strength or wound infection rates. This means that scarring may no longer be an inevitable consequence of modem injury or surgery and that a completely new pharmaceutical approach to the prevention of human scarring is now possible. Scarring after injury occurs in many tissues in addition to the skin. Thus scar-improving drugs could have widespread benefits and prevent complications in several tissues, e.g. prevention of blindness after scarring due to eye injury, facilitation of neuronal reconnections in the central and peripheral nervous system by the elimination of glial scarring, restitution of normal gut and reproductive function by preventing strictures and adhesions after injury to the gastrointestinal or reproductive systems, and restoration of locomotor function by preventing scarring in tendons and ligaments.
Ferguson, Mark W J; O'Kane, Sharon
Varying surgical techniques, patient groups and results have been described regards the surgical treatment of post traumatic flexion contracture of the elbow. We present our experience using the limited lateral approach on patients with carefully defined contracture types. Surgical release of post-traumatic flexion contracture of the elbow was performed in 23 patients via a limited lateral approach. All patients had an established flexion contracture with significant functional deficit. Contracture types were classified as either extrinsic if the contracture was not associated with damage to the joint surface or as intrinsic if it was. Overall, the mean pre-operative deformity was 55 degrees (95%CI 48 – 61) which was corrected at the time of surgery to 17 degrees (95%CI 12 – 22). At short-term follow-up (7.5 months) the mean residual deformity was 25 degrees (95%CI 19 – 30) and at medium-term follow-up (43 months) it was 32 degrees (95%CI 25 – 39). This deformity correction was significant (p < 0.01). One patient suffered a post-operative complication with transient dysaesthesia in the distribution of the ulnar nerve, which had resolved at six weeks. Sixteen patients had an extrinsic contracture and seven an intrinsic. Although all patients were satisfied with the results of their surgery, patients with an extrinsic contracture had significantly (p = 0.02) better results than those with an intrinsic contracture. (28 degrees compared to 48 degrees at medium term follow up). Surgical release of post-traumatic flexion contracture of the elbow via a limited lateral approach is a safe technique, which reliably improves extension especially for extrinsic contractures. In this series all patients with an extrinsic contracture regained a functional range of movement and were satisfied with their surgery.
Brinsden, Mark D; Carr, Andrew J; Rees, Jonathan L
Despite advances in breast implant surgery, capsular contracture remains a challenging sequela of reconstructive and cosmetic breast implant surgery. Although there are established modalities for treatment, most recently, acellular dermal matrix products have been suggested to have a role in preventing or diminishing the pathologic process of capsular contracture. In this article, the author presents a review of the literature to highlight the level of evidence on the role of acellular dermal matrices in the treatment of capsular contracture. PMID:23096960
Basu, C Bob; Jeffers, Lynn
Urinary incontinence postradical prostatectomy is a common problem which adversely affects quality of life. Concomitant bladder neck contracture in the setting of postprostatectomy incontinence represents a challenging clinical problem. Postprostatectomy bladder neck contracture is frequently recurrent and makes surgical management of incontinence difficult. The aetiology of bladder neck contracture and what constitutes the optimum management strategy are controversial. Here we review the literature and also present our approach.
King, Thomas; Almallah, Y. Zaki
Scar contracture is believed to be caused by the cell contractility during the remodeling phase of wound healing. Cell contractility is mediated by non-muscle myosin II (NMMII) and actin, but the temporal-spatial expression profile of NMMII isoforms A and B (IIA and IIB) during the remodeling phase and the role of NMMII in scar fibroblast tissue remodeling are unknown. Human scar tissue immunostained for IIA and IIB showed that both isoforms were highly expressed in scar tissue throughout the remodeling phase of repair and expression levels returned to normal after the remodeling phase. Human scar tissue immunostained for ?-, ?- and ?-smooth muscle actin showed that all isoforms were consistently expressed throughout the remodeling phase of repair. The ?- and ?-smooth muscle actin were widely expressed throughout the dermis, but ?-smooth muscle actin was only locally expressed within the dermis. In vitro, fibroblasts explanted from scar tissue were shown to express more IIA than fibroblasts explanted from normal tissue and scar fibroblasts contracted collagen lattices to a greater extent than normal fibroblasts. Blebbistatin was used to demonstrate the function of NMMII in collagen lattice contraction. In normal tissue, fibroblasts are stress-shielded from external tensile stress by the extracellular matrix. After dermal injury and during remodeling, fibroblasts are exposed to a matrix of increased stiffness. The effect of matrix stiffness on IIA and IIB expression was examined. IIA expression was greater in fibroblasts cultured in collagen lattices with increasing stiffness, and in fibroblasts cultured on glass slides compared with polyacrylamide gels with stiffness of 1 kPa. In conclusion, NMMII and actin isoform expression changes coordinately with the remodeling phase of repair, and NMMII is increased as matrix stiffness increases. As NMMII expression increases, so does the fibroblast contractility. PMID:21102503
Bond, Jennifer E; Ho, Trung Q; Selim, Maria Angelica; Hunter, Cedric L; Bowers, Edith V; Levinson, Howard
In frog ventricle, developed tension was markedly larger in response to depolarization caused by a voltage clamp step than to depolarization induced by high concentrations of potassium chloride. Measurement of extracellular potassium activity at the surface and at the depth of muscle during the development of contractures showed that the diffusion of potassium is much slower than the spread of depolarization through the cross section of muscle. These two observations suggest that competition between the depolarizing and the negative inotropic effects of an increase in the extracellular potassium ion concentration may determine the time course and magnitude of contractile tension in heart muscle.
Morad, M.; Reeck, S.; Rao, M.
Hypertrophic scarring after burns is an unsolved problem and remains as devastating today as it was in the 40s and it may be that the main reason for this is the lack of an accepted, useful animal model. The female, red Duroc pig was described as a model of hypertrophic scarring nearly 30 years ago but then vanished from the literature. This seemed strange since the authors reported that 12 of 12 pigs developed thick scar. In the mid 90s we explored the model and found that, indeed, the red Duroc pig does make thick scar. Other authors have established that the Yorkshire pig does not heal in this fashion so there is the possibility of a same species control. We have continued to explore the Duroc/Yorkshire model and herein describe our experiences. Is it a perfect model of hypertrophic scarring? No. Is it a useful model of hypertrophic scarring? Time will tell. We have now obtained gene expression data from the Duroc/Yorkshire model and analysis is underway.
Zhu, Kathy Q.; Carrougher, Gretchen J.; Gibran, Nicole S.; Isik, F. Frank; Engrav, Loren H.
Introduction: The aim of the article was to study the histopathological features of various lesions of Scarring Alopecia (SA) and to classify Primary SA on the basis of the predominant type of inflammatory cell component. Scarring or cicatricial alopecias are those that are produced as a result of the malformation, damage or destruction of the pilosebaceous follicles, which are replaced by cicatricial tissue, in such a way that they cannot again produce hair. Material and Methods: This prospective study included 32 biopsy – proven cases of SA, who had attended our hospital. Primary SA was classified according to the North American Hair Research Society. The informed consents of the subjects and the institutional ethical clearance was obtained for the study. The SPSS, version 14 software was used to analyse the data. Frequencies and percentages were used to describe the data. Results: During the study period, 32 cases of scarring alopecia were diagnosed, of which 24 were primary SA and 8 were secondary SA. Among the primary SA, there were 23 cases of lymphocyte associated primary scarring alopecias, of which, 19 of lupus erythematosus, 3 of lichen planopilaris (LPP) and one case of non specific SA. 1 case of neutrophil associated primary scarring (folliculitis decalvans) was also noted and among the secondary SA, there were 4 cases of morphea and 1 case each of lupus vulgaris, congenital absence of skin, burn and sarcoidosis. Conclusion: To conclude, histopathology is a dependable tool for identifying the underlying cause in scarring alopecia, which is helpful for an early diagnosis and treatment.
Kumar U., Mahesh; Yelikar, Balasaheb Ramling
Do relativistic quantum scars in classically chaotic systems possess unique features that are not shared by nonrelativistic quantum scars? We report a class of relativistic quantum scars in massless Dirac fermion systems whose phases return to the original values or acquire a 2? change only after circulating twice about some classical unstable periodic orbits. We name such scars chiral scars, the successful identification of which has been facilitated tremendously by our development of an analytic, conformal-mapping-based method to calculate an unprecedentedly large number of eigenstates with high accuracy. Our semiclassical theory indicates that the physical origin of chiral scars can be attributed to a combined effect of chirality intrinsic to massless Dirac fermions and the geometry of the underlying classical orbit. PMID:23432246
Xu, Hongya; Huang, Liang; Lai, Ying-Cheng; Grebogi, Celso
Acne has a prevalence of over 90% among adolescents and persists into adulthood in approximately 12%-14% of cases with psychological and social implications. Possible outcomes of the inflammatory acne lesions are acne scars which, although they can be treated in a number of ways, may have a negative psychological impact on social life and relationships. The main types of acne scars are atrophic and hypertrophic scars. The pathogenesis of acne scarring is still not fully understood, but several hypotheses have been proposed. There are numerous treatments: chemical peels, dermabrasion/microdermabrasion, laser treatment, punch techniques, dermal grafting, needling and combined therapies for atrophic scars: silicone gels, intralesional steroid therapy, cryotherapy, and surgery for hypertrophic and keloidal lesions. This paper summarizes acne scar pathogenesis, classification and treatment options. PMID:20981308
Fabbrocini, Gabriella; Annunziata, M C; D'Arco, V; De Vita, V; Lodi, G; Mauriello, M C; Pastore, F; Monfrecola, G
A man with hilar adenopathy had smooth firm purplish papules (lupus pernio) on his face and pseudofolliculitis barbae (PFB) in his beard area. Biopsies of papules of both the lupus pernio and the PFB revealed non-caseating granulomas consistent with sarcoidosis. This is the first case report of sarcoidosis infiltrating lesions of PFB and the first of lupus pernio co-existing with scar sarcoidosis. In persons with suspected sarcoidosis, enlarged lesions of PFB are sites suitable for confirmatory biopsy. In addition, persons who develop keloid-like papules within their PFB may be providing an early cutaneous clue to undiagnosed systemic sarcoidosis. PMID:1922852
Norton, S A; Chesser, R S; Fitzpatrick, J E
The contact thermal injury model in the pig was used to determine whether immediate burn excision could alter the extent of injury progression. It was hypothesized that immediate excision of burns would prevent or reduce tissue necrosis in the uninjured interspaces. Four comb burns were created on the back of each animal, using a brass comb preheated in hot water (100 °C) for 5 minutes. This brass comb produced four distinctive burns sites separated by three "interspaces" of unburned skin, which were to undergo progressive injury. Immediately after burn creation, half of the full-thickness burns were excised leaving the unburned interspaces intact. Two full-thickness excisional wounds per pig with the dimensions identical to the comb burns were included as controls. Burn injury progression was microscopically assessed and reported as the percentage of unburned interspaces that progressed to full-thickness necrosis 7 days after injury. Scar formation was grossly evaluated on day 28 after injury and reported as the total surface area (in square centimeters) of the scar. A total of 24 combs with 72 interspaces were evenly distributed among the three groups. The unburned interspaces of both comb burns and excised comb burns had undergone progressive injury and were 100% dead (24/24; i.e., necrotic and/or apoptotic) 7 days postinjury (95% confidence interval, 86-100%) for both. However, interspaces of the control excisional wounds maintained complete viability, that is, no necrosis or apoptosis (0/24 [0%]; 95% confidence interval, 0-14%; P < .001). There was no significant difference in both surface area and depth of scar resulting from excised and nonexcised comb burns. Immediate burn excision neither prevented nor limited burn injury progression. PMID:23624996
Macri, Lauren K; Singer, Adam J; Taira, Breena R; McClain, Steve A; Rosenberg, Lior; Clark, Richard A F
Background Splinting as part of the overall post-surgical management of patients after release of Dupuytren's contracture has been widely reported, though there is variation in practice and criteria for using it. The evidence on its effectiveness is sparse, of poor quality and contradictory with studies reporting negative and positive effects. Methods/Design A multi-centre, pragmatic, randomized, controlled trial is being conducted to evaluate the effect of static night splinting for six months on hand function, range of movement, patient satisfaction and recurrence at 1 year after fasciectomy or dermofasciectomy. Using a centrally administered computer randomization system consented patients will be allocated to one of two groups: i) splint group who will be given a static splint at approximately 10 to 14 days after surgery to be worn for 6 months at night time only as well as hand therapy; ii) non-splint group, who will receive hand therapy only. The primary outcome measure is the patient-reported Disabilities of the Arm, Hand and Shoulder Questionnaire (DASH). Secondary outcomes are total active flexion and extension of fingers, patient satisfaction and recurrence of contracture. Outcome measures will be collected prior to surgery, 3 months, 6 months and 1 year after surgery. Using the DASH as the primary outcome measure, where a difference of 15 points is considered to be a clinically important difference a total of 51 patients will be needed in each group for a power of 90%. An intention-to-treat analysis will be used. Discussion This pragmatic randomized controlled trial will provide much needed evidence on the clinical effectiveness of post-operative night splinting in patients who have undergone fasciectomy or dermofasciectomy for Dupuytren's contracture of the hand. Trial Registration Current Controlled Trials ISRCTN 57079614
Jerosch-Herold, Christina; Shepstone, Lee; Chojnowski, Adrian J; Larson, Debbie
Masseter muscle rigidity (MMR) induced during general anaesthesia by suxamethonium is a clinical problem that may interfere with tracheal intubation. We have investigated the relation between twitch tension and contracture response to suxamethonium in rats. Rats were anaesthetized with 1% halothane (1.35 MAC). Jaw muscle temperature was maintained at either 37 or 41 degrees C while rectal temperature was kept at 37 degrees C by radiant heat. Twitch tension was produced by nerve stimulation at 0.2 Hz. Rats were pretreated with either a low dose of vecuronium (0.03 mg kg-1) or dantrolene (0.8 mg kg-1). Thereafter suxamethonium 750 micrograms kg-1 was administrated i.v. Low-dose vecuronium pretreatment significantly (90%) decreased suxamethonium-induced jaw muscle contracture (JMC) with minimal (3%) twitch block during local hyperthermia. Low-dose dantrolene pretreatment also reduced JMC (81% at 37 degrees C and 82% at 41 degrees C) while decreasing twitch by 30% at 37 degrees C and 31% at 41 degrees C. Both vecuronium and dantrolene at doses that minimally depressed the twitch response antagonized suxamethonium-induced JMC. We speculate that pretreatment with low-dose vecuronium decreases suxamethonium-induced MMR clinically. PMID:9135319
Shi, Y; Storella, R J; Keykhah, M M; Rosenberg, H
Dupuytren's disease is a fibroproliferative condition involving the superficial palmar fascia, leading to a progressive and irreversible flexion of the fingers. In literature, there are different opinions regarding the phenobarbital, a common antiepileptic drug, and its effective role in the genesis and development of Dupuytren's disease. In this retrospective investigation the association between phenobarbital and Dupuytren's contracture is discussed. Three patients in treatment with phenobarbital who had no others significant risk factors for Dupuytren's contracture were included in this study. The disease occurred after one to four years of drug therapy, at dosage of 100 mg/day. After surgery, Dupuytren's disease showed different evolutions in relation to dosage and type of antiepileptic drug used. Phenobarbital causes a dose and time-dipendent profibrotic effect. A clinical regression was observed when phenobarbital was substituted by carbamazepine, maintaining the same dosage (100 mg/day). This data confirms that not all the antiepileptic drugs are implicated in palmar fibrosis, and suggests that, according to the efficacy and adverse effects, the administration of benzodiazepine reduces the risk of Dupuytren's recurrence. PMID:21528776
Tripoli, M; Cordova, A; Moschella, F
Although scars are a normal part of the healing process, facial scars have significant implications on a patient's well-being, both physically and psychologically. Facial scars are one of the most common reasons a patient presents to the facial plastic and reconstructive surgeon. The ability to evaluate facial scars and choose the most appropriate technique for revision is of paramount importance to obtain the best result. A thorough understanding of superficial facial anatomy and principles of wound healing is equally as important as meticulous technical execution. Above all, the expectations of the patient must be assessed and considered when formulating a surgical plan. PMID:23027214
Watson, Deborah; Reuther, Marsha Sonia
Vocal fold scarring remains a significant problem. Although several animal models have been developed to improve our understanding of the histopathology, the histologic features of scarred human vocal folds have rarely been reported. The present case studies aimed to define the histologic changes of scarred human vocal folds caused by cordectomy or cordotomy. Ten patients with the scarred vocal folds were involved in this study. Nine patients with early glottic cancer underwent endoscopic cordectomy, and one patient underwent superficial cordotomy for idiopathic scar. The postcordectomy or cordotomy scar was biopsied or resected 3-13 months after the original procedure. After confirming absence of any tumor in cancer patients, the remaining specimens were used in the present study. Histologic examination investigated deposition of extracellular matrix (ECM) including collagen, elastin, hyaluronic acid (HA), fibronectin, and decorin in the lamina propria of the scarred vocal folds. There was a wide range of variation in the deposition of ECM in scarred vocal folds. Excessive and disorganized collagen deposition was observed in most cases that had undergone deep resection of the lamina propria, whereas deposition of collagen was mild and well organized after superficial resection. Decorin was retained in all cases after superficial cordectomy or cordotomy, but varied after deep resection. Deposition of elastin, HA, and fibronectin varied regardless of depth of injury. Histology of scarred vocal folds may vary with degree of injury and individual healing mechanism. PMID:18395421
Hirano, Shigeru; Minamiguchi, Sachiko; Yamashita, Masaru; Ohno, Tsunehisa; Kanemaru, Shin-Ichi; Kitamura, Morimasa
Summary Scar management for the prevention of excessive scar formation has always been important but never so important as it is today. Optimal management continues to be an enigma for surgeons, and the best modality of treatment has been debated for many years. However, most studies have unfortunately been either retrospective or case report descriptions. Advances in scar management have been hampered by confusing or ambiguous terminology. There is no consensus on what amount of post-traumatic skin scar formation is "normal" and what should be considered "hypertrophic". In the World Health Organization's ICD-9, there is no diagnostic code for hypertrophic scar - only keloid is listed. Yet the medical and scientific literature distinguishes them as different conditions. This confusion results in inappropriate management of scar formation, and occasionally contributes to decision making related to elective or cosmetic surgery. Our experience suggests that there is no single treatment for scars that is adequate and that clinical judgement is very important when considering treatment and balancing the potential benefits of the various treatments available. The goal of treating scars is to restore functionality, provide relief of symptoms, enhance cosmetics, and prevent recurrence. This article is based on our scientific and clinical experiences and focuses on over-the-counter options to manage keloid and hypertrophic scars.
Edriss, A.S.; Mestak, J.
Central or eccentric scar has been described in (most frequently) focal nodular hyperplasia (FNH), large hemangioma, and fibrolamellar hepatocellular carcinoma, and moreover, a central scar may be rarely seen in conventional nonfibrolamellar hepatocellular carcinoma, (peripheral type) cholangiocarcinoma, and some hepatic metastases. Among the liver tumors with central or eccentric scar, differentiating FNH from other solid hepatic tumors is important because FNH usually requires no treatment. Multiphasic computed tomography and magnetic resonance imaging are useful for the differential diagnosis of liver tumors with central or eccentric scar. Liver-specific magnetic resonance contrast media will improve the differentiation between FNH and other solid hepatic tumors. PMID:19842566
Kim, Tonsok; Hori, Masatoshi; Onishi, Hiromitsu
We present a new and simple technique for the treatment of proximal interphalangeal (PIP) joint contractures by mini Orthofix external fixator without open surgery. The technique was tested on 10 patients. We found that the fixator is easy to apply and effective in reducing contractures of the PIP joint by soft tissue distraction. PMID:15180240
Houshian, Shirzad; Schrøder, Henrik A
Prenecrotic contracture changes in cardiomyocytes during ischemic and metabolic alteration of the myocardium are detected at the photooptic level by photochemical fluorochrome staining and examination in fluorescent light. Comparison of the fluorescent and polarization microscopic pictures of damaged cardiomyocytes showed relationships between optically active and isotropic constituents of the cell myofibrillar system. Contracture changes are determined by local mass redistribution
L. M. Nepomnyashchikh; V. G. Zimmermann
Surface wave patterns are investigated experimentally in a system geometry that has become a paradigm of quantum chaos: the stadium billiard. Linear waves in bounded geometries for which classical ray trajectories are chaotic are known to give rise to scarred patterns. Here, we utilize parametrically forced surface waves (Faraday waves), which become progressively nonlinear beyond the wave instability threshold, to investigate the subtle interplay between boundaries and nonlinearity. Only a subset (three main types) of the computed linear modes of the stadium are observed in a systematic scan. These correspond to modes in which the wave amplitudes are strongly enhanced along paths corresponding to certain periodic ray orbits. Many other modes are found to be suppressed, in general agreement with a prediction by Agam and Altshuler based on boundary dissipation and the Lyapunov exponent of the associated orbit. Spatially asymmetric or disordered (but time-independent) patterns are also found even near onset. As the driving acceleration is increased, the time-independent scarred patterns persist, but in some cases transitions between modes are noted. The onset of spatiotemporal chaos at higher forcing amplitude often involves a nonperiodic oscillation between spatially ordered and disordered states. We characterize this phenomenon using the concept of pattern entropy. The rate of change of the patterns is found to be reduced as the state passes temporarily near the ordered configurations of lower entropy. We also report complex but highly symmetric (time-independent) patterns far above onset in the regime that is normally chaotic. PMID:11308559
Kudrolli, A; Abraham, M C; Gollub, J P
Axillary burns and contractures are physically debilitating. Early splinting and patient compliance is crucial to maximise functional outcomes. Traditional treatment of axillary contractures involves fabrication of thermoplastic aeroplane splints. However, thermoplastic splints can be time consuming to fabricate, heavy, uncomfortable and difficult to don by patients and family. Due to these problems a modified high-density foam (HDF) aeroplane splint was designed. The purpose of designing a different type of aeroplane splint was to increase compliance, comfort and ease of use for health professionals, patients and family, and to decrease fabrication time. PMID:16997477
Chown, Gregory A
Provide by Burns Country, this full-text, online version of "the definitive Robert Burns reference volume" serves as a useful handbook to Scotland's most famous poet and the intellectual circles in which he turned. The encyclopedia, which is in HTML format, is organized alphabetically. Burns Country offers a number of other related resources, chief among them a songs and poems archive containing 100 of the poet's works. Other features at the site include a discussion area, Burns and Scottish association links, and some commercial content.
Umbilical scarring is the presence of excess scar tissue deposited between abdominal dermal layers at the site of yolk sac absorption in hatchling American alligators (Alligator mississippiensis). The presence of this dermal condition plays a key evaluatory role in the overall quality and subsequent value for various commercial leather products. Despite the prevalent nature of this condition, currently the industry
J. J. Wiebe; M. S. Sepúlveda; J. E. Buckland; S. R. Anderson; T. S. Gross
Today, wound management to avoid excessive scar formation is increasingly important, especially in populations with Fitzpatrick 3 or higher skin pigmentation. Medical science and industrial development are devoting more effort toward understanding and offering better therapy to control scars. However, advances in scar management have been hampered by the confusing or ambiguous terminology. There is no consensus on what amount of post-traumatic skin scar formation is "normal" and what should be considered "hypertrophic". In the World Health Organization's ICD-9, there is no diagnostic code for hypertrophic scar--only keloid is listed. Yet, the medical and scientific literature distinguishes them as different conditions. Our experience suggests that the diagnosis of keloid disease is greatly over-rendered. For black patients, an elevated scar seems, by default, diagnosed as keloid by most. This confusion results in inappropriate management of scar formation, and occasionally contributes to decision making related to elective or cosmetic surgery. Given that patients are expecting better outcomes from wound care today than in the past, this review article attempts to capture the essential biological factors related to wound scar production and discusses treatment options and indications used by the authors. Images Figure 1 Figure 2 Figure 3
Roseborough, Ingrid E.; Grevious, Mark A.; Lee, Raphael C.
Background Dupuytren's contracture is a condition of the palmar fascia involving contractures of the fascia and skin in the hand. Current treatment for Dupuytren's contracture is mainly limited to surgery. In the Netherlands, little is known about the prevalence of Dupuytren's contracture. In this study we determined the prevalence of patients with a hospitalization for Dupuytren's contracture in the Netherlands and characterized their (re)hospitalizations. Methods From the PHARMO database, which consists of multiple observational databases linked on a patient level, all patients hospitalized for Dupuytren's contracture between 2004 and 2007 were included in the source population (ICD-9-CM code 728.6). Numbers from this source population were used to provide estimates of hospitalizations for Dupuytren's contracture in the Netherlands. Patients with a medical history in the PHARMO database of at least 12 months before their hospitalization were included in the study cohort and followed until end of data collection, death, or end of study period, whichever occurred first. Type of admission, length of stay, recorded procedures, treating specialty, number of rehospitalizations for Dupuytren's contracture, and time to first rehospitalization were assessed. Results Of 3, 126 patients included in the source population, 3, 040 were included in the study population. The overall prevalence of patients with a hospitalization for Dupuytren's contracture was 0.04%, with the highest prevalence (0.25%) among 60-79 year old males. The majority (85%) of all hospitalizations were day-case admissions. Of the admitted inpatients (15%) the majority (81%) had one overnight stay in the hospital. The most common recorded procedure was fasciectomy (87%) and 78% of patients was treated by a plastic surgeon. During a median (IQR) follow-up of 2.9 (1.8-4.0) years, 523 patients were rehospitalized for Dupuytren's contracture. The median (IQR) time to first rehospitalization was 0.8 (0.4-1.9) years. Conclusions This study is a first exploration of Dupuytren's contracture in the Netherlands based on hospitalizations, showing a prevalence of 0.25% among 60-79 year old males. Future studies should also address outpatient procedures to get a complete picture of the treatment of Dupuytren's contracture. In addition, patients not yet treated should be included to be able to estimate the prevalence of Dupuytren's contracture.
We investigated a large German family (n = 37) with male members who had contractures, rigid spine syndrome, and hypertrophic cardiomyopathy. Muscle weakness or atrophy was not prominent in affected individuals. Muscle biopsy disclosed a myopathic pattern with cytoplasmic bodies. We used microsatellite markers and found linkage to a locus at Xq26-28, a region harboring the FHL1 gene. We sequenced FHL1 and identified a new missense mutation within the third LIM domain that replaces a highly conserved cysteine by an arginine (c.625T>C; p.C209R). Our finding expands the phenotypic spectrum of the recently identified FHL1-associated myopathies and widens the differential diagnosis of Emery-Dreifuss-like syndromes. PMID:20186852
Knoblauch, Hans; Geier, Christian; Adams, Stephanie; Budde, Birgit; Rudolph, André; Zacharias, Ute; Schulz-Menger, Jeannette; Spuler, Andreas; Yaou, Rabah Ben; Nürnberg, Peter; Voit, Thomas; Bonne, Gisele; Spuler, Simone
In his position as curator of the Cowlishaw collection of historical medical books in the Library of the College, Kenneth Russell prepared the definitive catalogue of the collection. This catalogue is comprehensive and for almost all entries there is an annotation that demonstrates his meticulous attention to detail and the love of the book collection that he managed to secure for the College. It is from this catalogue that I have chosen two books in particular that bring together two great surgeons of the turn of the 19th century. Although he was a pupil of the great John Hunter, the young Astley Cooper possessed good manners and a gift of oratory of which the Scot, his teacher, was devoid. After his apprenticeship with Henry Cline senior, Cooper came to share the podium with Cline at Guy's and St Thomas' hospitals and the two dominated surgical teaching in London for some 22 years, until Cline's retirement in 1811. It was the latter who was first to recognize the true nature of the condition now known as Dupuytren's disease. Later, in 1822, Cooper wrote a detailed description of the contracture of the palmar aponeurosis and recommended fasciotomy as being curative. His book A Treatise on Dislocations and Fractures of the Joints, which contains this description of Dupuytren's contracture, is held in the Cowlishaw Collection. On the other side of the English Channel, M. le Baron Dupuytren repeatedly misquoted Cooper and stated that Cooper believed that the disease was incurable. In his famous lecture given to the staff of the Hôtel Dieu in Paris on 5th December 1931, he admitted to having seen 30 or 40 cases over 20 years of practice. It seems likely that he was not aware of the true cause of the condition before 1831 when he treated his first case. This lecture, along with others, are recorded in his Leçons Orales de Clinique Chirurgicale, a copy of which is also to be found in the Cowlishaw Collection. PMID:12864830
This is a report of studies of time-dose relationships for post-irradiation leg contractures in mice. The isoeffect doses for various degrees of contracture, measured 250 days after irradiation, increased with the number of fractions, but not with the overall treatment times, throughout 30 days. The isoeffect curves relating the total doses for given levels of responses to the doses per fraction were steeper for leg contractures than for acute skin reactions. The alpha/beta ratios ranged from 1.4 to 5.0 Gy, depending on the degrees of contracture. They were less than the 7.5 to 50 Gy for acute skin reactions as determined in previous experiments using the same animals and irradiation systems. Thus, the data resembled those from other slowly-responding normal tissues such as the spinal cord, kidney and lung. The leg contracture consisted of dermatogenic, myogenic, and arthrogenic components; after the mice were sacrificed there was residual contracture following removal of the skin and muscle. Inhibition of bone growth accounted for only a small proportion of the contracture. The overall response reflected responses of several tissue types.
Masuda, K.; Hunter, N.; Stone, H.B.; Withers, H.R.
Objective: Capsular contracture is a common complication associated with reconstructive breast surgery. The optimal time interval between the completion of tissue expansion and placement of the permanent implant is arbitrary and incompletely studied in the literature. The aim of the study was to determine whether the time interval between completion of expansion and placement of the permanent implant would affect the incidence of capsular contracture. Methods: We conducted a retrospective study of 112 patients with breast cancer, including 140 breasts, who underwent postmastectomy tissue expander placement between 1997 and 2004. All patients underwent replacement of tissue expander with a permanent prosthesis. Data were collected retrospectively, including whether the patient smoked, underwent radiation therapy, had saline or silicone implant reconstruction, required reoperation after tissue expander placement or after permanent implant placement, Baker classification, and the interval between completion of expansion and placement of permanent implant. Results: We used a logistic regression model to incorporate the predictors of capsular contracture. Keeping all other predictors constant, we found that the time interval between implant exchange had no effect on capsular contracture. The only significant predictor of capsular contracture was whether the patient required a reoperation after the permanent implant was placed (P = .0001). Conclusions: Allowing the capsule around a tissue expander to mature does not significantly affect development of capsular contracture. However, a complication that necessitates disrupting the periprosthetic capsule of the permanent implant with an operation significantly increases odds of developing contracture.
Weintraub, Jennifer L.; Kahn, David M.
This paper presents a retrospective study of the use of 346 expanders in 132 patients operated at the Ivo Pitanguy Clinic, between the period of 1985 and 2000. The expanders were used in the treatment of burn sequela. In the majority of cases, more than one expander was used at the same time. In 42 patients, repeated tissue expansion was done. The re-expanded flaps demonstrated good distension and viability. With the increase in area at each new expansion, larger volume expanders were employed, achieving an adequate advancement of the flaps to remove the injured tissue. The great advantage of using tissue re-expansion in the burned patient is the reconstruction of extensive areas with the same color and texture of neighboring tissues, without the addition of new scars. PMID:12163292
Pitanguy, Ivo; Gontijo de Amorim, Natale Ferreira; Radwanski, Henrique N; Lintz, José Eduardo
Under normal conditions, the Arp2/3 complex activator SCAR/WAVE controls actin polymerization in pseudopods, whereas Wiskott–Aldrich syndrome protein (WASP) assembles actin at clathrin-coated pits. We show that, unexpectedly, Dictyostelium discoideum SCAR knockouts could still spread, migrate, and chemotax using pseudopods driven by the Arp2/3 complex. In the absence of SCAR, some WASP relocated from the coated pits to the leading edge, where it behaved with similar dynamics to normal SCAR, forming split pseudopods and traveling waves. Pseudopods colocalized with active Rac, whether driven by WASP or SCAR, though Rac was activated to a higher level in SCAR mutants. Members of the SCAR regulatory complex, in particular PIR121, were not required for WASP regulation. We thus show that WASP is able to respond to all core upstream signals and that regulators coupled through the other members of SCAR’s regulatory complex are not essential for pseudopod formation. We conclude that WASP and SCAR can regulate pseudopod actin using similar mechanisms.
Veltman, Douwe M.; King, Jason S.; Machesky, Laura M.
An observational study was carried out at the Plastic and Reconstructive Surgery Unit of the University of Pavia - Salvatore Maugeri Research and Care Institute, Pavia, Italy, to assess the clinical and histological long-term outcomes of autologous skin grafting of fresh surgical wounds following previous repair with a hyaluronic acid three-dimensional scaffold (Hyalomatrix®). Eleven fresh wounds from surgical release of retracted scars were enrolled in this study. A stable skin-like tissue cover was observed in all of the treated wounds in an average 1 month's time; at the end of this study, after an average of 12 months' time, all of the reconstructed areas were pliable and stable, although an average retraction rate of 51·62% was showed. Histological observation and immunohistochemical analysis displayed integration of the graft within the surrounding tissues. A regenerated dermis with an extracellular matrix rich in type I collagen and elastic fibres and with reduced type III collagen rate was observed. The epidermis and dermoepidermal junction featured a normal appearance with well-structured dermal papillae, too. Although the histological features would suggest regeneration of a skin-like tissue, with a good dermis and no signs of scarring, the clinical problem of secondary contracture is still unsolved. PMID:22630331
Faga, Angela; Nicoletti, Giovanni; Brenta, Federica; Scevola, Silvia; Abatangelo, Giovanni; Brun, Paola
ATSR?2 active fire data from 1996 to 2000, TRMM VIRS fire counts from 1998 to 2000 and burn scars derived from SPOT VEGETATION (the Global Burnt Area 2000 product) were mapped for Peru and Bolivia to analyse the spatial distribution of burning and its intra? and inter?annual variability. The fire season in the region mainly occurs between May and October;
A. V. Bradley; A. C. Millington
OBJECTIVES: This study examined determinants of modern health care use by families after their child aged 0-5 years sustained a burn injury in the Ashanti Region of Ghana. METHODS: A community based survey of children aged 0-5 years was conducted in 50 enumeration areas in the region. Mothers of all children with scars as evidence of a burn were selected
S. N. Forjuoh; B. Guyer; D. M. Strobino
The idea of burning oil slicks at sea has intrigued oil-cleanup managers for more than a decade, but it wasn't until the advent of fireproof booms in the mid-1980's and a major spill opportunity (the March 1989 Exxon Valdez) that in-situ burning got a real sea trial. The results of this and other burning experiments indicate that, when conditions allow it, nothing can compete with fire's ability to remove oil from water. Burns have the potential to remove as much oil in one day as mechanical devices can in one month, along with minimal equipment, labor and cost. Reluctance to burn in appropriate situations comes primarily from the formation of oily, black smoke. Analysis of the potentially toxic gases have been done, indicating that burning will not increase the levels of polluting aldehydes, ketones, dioxins, furans, and PAHs above those that normally evaporate from spilled oil. This article contains descriptions of planned oil fires and the discussion on the advantages and concerns of such a policy.
Capsular contracture is one of the major complications of augmentation mammaplasty. A review of 638 augmented breasts in 319 consecutive patients who underwent primary augmentation, with an average follow-up of 17.2 months and without a single case of capsular contracture of any degree to date, is presented, along with a discussion of the surgical technique and complications, and an analysis of measures used to prevent capsular contraction. Each patient received a pair of smooth saline-filled implants (Mentor, USA) placed in the submuscular space through an inframammary incision. In all operated breasts, many of the known measures commonly used for capsular contracture prevention were implemented. As well, a dependent drain was used as the final hemostatic step to prevent blood accumulation in the pocket. Leaving a dependent drain in the dissected pocket overnight, as one of the sequence of measures aimed at eliminating blood accumulation, is believed to be a contributing factor in capsular contracture prevention.
Fanous, Nabil; Salem, Iman; Tawile, Carolyne; Bassas, AE
This invention relates to an extension splint that lengthens the muscle and soft tissue about an extremity or limb synovial hinge joint to assist in rehabilitating flexion contractures caused by soft tissue injury. More particularly, the invention relates...
The reported incidence of persistent knee flexion contracture following total knee arthroplasty (TKA) has varied from 1-15 percent Various treatment modalities have been described in attempts to manage this often difficult problem. This paper describes a novel method of treatment by using a hinged cast brace (previously reported for treatment of femur fractures and knee contractures secondary to hemophilia and cerebral palsy) for use in patients with symptomatic knee flexion contractures. Application of this cast brace with frequent adjustment (every three to four days, initially) toward full extension can often improve knee extension, after physical therapy and other modalities such as extension-assist braces have failed. Care must be taken in the application and use of this device which utilizes frequent manipulations to reduce and maintain the knee flexion angle. We report two clinical cases in which this protocol was effectively used in decreasing symptomatic knee flexion contractures.
Karam, Matthew D; Pugely, Andrew; Callaghan, John J; Shurr, Donald
Thyroidectomy has few complications, as a result, many patients are concerned about the prominence of their scar. Performing\\u000a thyroid surgery through excessively small incisions in order to maximise cosmesis may increase the likelihood of complications.\\u000a This study investigates the relationship between conventional approach thyroidectomy scar length and patient satisfaction.\\u000a A validation of self-measurement of neck circumference and thyroidectomy scar was
E. C. Toll; P. Loizou; C. R. Davis; G. C. Porter; D. D. Pothier
Background Undiagnosed patients with the attenuated form of mucopolysaccharidosis (MPS) type I often have joint symptoms in childhood that prompt referral to a rheumatologist. A survey conducted by Genzyme Corporation of 60 European and Canadian rheumatologists and pediatric rheumatologists demonstrated that < 20% recognized signs and symptoms of MPS I or could identify appropriate diagnosis tests. These results prompted formation of an international working group of rheumatologists, pediatric rheumatologists, and experts on MPS I to formulate a rheumatology-based diagnostic algorithm. The resulting algorithm applies to all MPS disorders with musculoskeletal manifestations. Bone and joint manifestations are prominent among most patients with MPS disorders. These life-threatening lysosomal storage diseases are caused by deficient activity of specific enzymes involved in the degradation of glycosaminoglycans. Patients with attenuated MPS disease often experience diagnostic delays. Enzyme replacement therapy is now commercially available for MPS I (laronidase), MPS II (idursulfase), and MPS VI (galsulfase). Presentation of the hypothesis Evolving joint pain and joint contractures in the absence of inflammation should always raise the suspicion of an MPS disorder. All such patients should undergo urinary glycosaminoglycan (uGAG) analysis (not spot tests for screening) in a reputable laboratory. Elevated uGAG levels and/or an abnormal uGAG pattern confirms an MPS disorder and specific enzyme testing will determine the MPS type. If uGAG analysis is unavailable and the patient exhibits any other common sign or symptom of an MPS disorder, such as corneal clouding, history of hernia surgery, frequent respiratory and/or ear, nose and throat infections; carpal tunnel syndrome, or heart murmur, proceed directly to enzymatic testing. Refer patients with confirmed MPS to a geneticist or metabolic specialist for further evaluation and treatment. Testing of the hypothesis We propose that rheumatologists, pediatric rheumatologists, and orthopedists consider our diagnostic algorithm when evaluating patients with joint pain and joint contractures. Implications of the hypothesis Children and young adults can suffer for years and sometimes even decades with unrecognized MPS. Rheumatologists may facilitate early diagnosis of MPS based on the presenting signs and symptoms, followed by appropriate testing. Early diagnosis helps ensure prompt and appropriate treatment for these progressive and debilitating diseases.
Cimaz, Rolando; Coppa, Giovanni Valentino; Kone-Paut, Isabelle; Link, Bianca; Pastores, Gregory M; Elorduy, Maria Rua; Spencer, Charles; Thorne, Carter; Wulffraat, Nico; Manger, Bernhard
The development of hypertrophic scar involves a complex interplay between cells and cytokines. Although the mechanism underlying its pathogenesis is not well understood, a polarized T-helper type 2 immune response has been reported, indicating a role for CD4+ T lymphocytes in hypertrophic scarring. Here, we report an increased frequency of CD4+/transforming growth factor-beta (TGF-beta)-producing T cells in the peripheral blood and hypertrophic scar tissue of burn patients. These cells may play an indirect regulatory role in hypertrophic scar by affecting the functions of dermal fibroblasts. Our results show an increase in cell proliferation and collagen synthesis by dermal fibroblasts treated with medium derived from burn patient CD4+ T lymphocytes but not from the CD4+ T cells of normal subjects. Using confocal microscopy and immunoblotting, we found the level of alpha-smooth muscle actin to be elevated in these treated dermal fibroblasts, which also showed an enhanced ability to contract collagen lattices. TGF-beta levels in medium conditioned by the culture of CD4+ T lymphocytes from burn patients were significantly higher than in the conditioned medium from CD4+ T lymphocytes of normal subjects. In addition, the application of a TGF-beta-neutralizing antibody significantly reduced the effect of burn patient CD4+ T lymphocyte medium on dermal fibroblast proliferation and collagen lattice contraction. Our study suggests that CD4+/TGF-beta-producing T lymphocytes may play an important role in postburn hypertrophic scarring. PMID:17650097
Wang, Jianfei; Jiao, Haiyan; Stewart, Tara L; Shankowsky, Heather A; Scott, Paul G; Tredget, Edward E
Two groups of patients are compared with respect to capsular contracture after insertion of silicone breast prostheses. Six hundred seventy four women received single-lumen gel prostheses and 700 received double-lumen prostheses with cortisone. The addition of 12.5 mg of prednisolone to double-lumen prostheses diminished capsular contracture (Baker II to IV) dramatically; in patients with simple augmentation from 19% to 4.9%,
Gottfried Lemperle; Klaus Exner
We describe six patients with classical levodopa-responsive Parkinson’s disease (PD) and one case of levodopa-responsive\\u000a familial juvenile dystonia-parkinsonism with fixed contractures of the hands, feet or legs. In most patients contractures\\u000a became established over a short period (2 months–2 years) but a considerable time after onset of parkinsonism (mean 13 years).\\u000a Mean disease duration was 17 years, and all patients
Michele T. M. Hu; Jeremy Bland; Chris Clough; Catherine M. Ellis; K. Ray Chaudhuri
The effects of adrenaline and the ?-adrenergic agonist isoprenaline on K+-evoked tension (K+-contracture) and Ba2+ current were investigated in chicken slow (anterior latissimus dorsi (ald)) muscle using isometric-tension measurements and current recording. Addition of adrenaline (10?7–10?5M) or isoprenaline (10?6–10?5 M) to the bath reduced the amplitude of the K+-contractures. These effects were blocked by the ?-antagonist propranolol (5 × 10?6
Xóchitl Trujillo; Miguel Huerta; Clemente Vásquez; Felipa Andrade
INTRODUCTION: Capsular contracture after augmentation mammoplasty occurs at a rate of 15% to 45%. The purpose of the present study was to determine the effect of implant core type (silicone versus saline) on the rate of capsular contracture in augmentation mammoplasty. METHODS: A systematic review was conducted through a search of three electronic databases. Two reviewers independently scanned titles yielded by the search and identified potentially relevant papers. Inter-reviewer variability and the scientific quality of the articles were assessed. Meta-analysis was performed. RESULTS: Eighty-eight titles of potential relevance were selected from the 393 articles yielded by the search. Inter-rater agreement for selection of potentially relevant articles was 84% (?=0.54). Four comparative studies were included in the analysis. Scientific quality scores of the included studies ranged from 5 of 14 to 9 of 14. Three of the four studies reported a higher rate of capsular contracture in patients with silicone implants. A combined odds ratio calculated on two of the studies found a 2.25-fold increased risk of capsular contracture in patients who received silicone implants. Eight series of patients who received cohesive gel silicone implants reported rates of capsular contracture from 0% to 13.6%. CONCLUSIONS: Higher rates of capsular contracture were found in patients who received silicone implants when compared with those who received saline implants. However, the scientific quality of the comparative studies to date on this subject is poor. Recent series evaluating cohesive gel implants report relatively low rates of capsular contracture. A randomized controlled trial comparing rates of capsular contracture in cohesive gel and saline implants is recommended.
El-Sheikh, Yasser; Tutino, Roberto; Knight, Casey; Farrokhyar, Farough; Hynes, Nicolas
Background: The pathogenesis of periprosthetic capsular contracture following breast implant surgery is unclear. The aim of this study was to identify the expression of tumour necrosis factor-? (TNF-?), collagen type III ?1 (COL3A1), transforming growth factor-?1 (TGF-?1) and connective tissue growth factor (CTGF) in different Baker grades of breast capsular contracture. Methods: Seven periprosthetic breast capsule specimens were collected from
K. T. Tan; D. Wijeratne; B. Shih; A. D. Baildam; A. Bayat
The basic principles influencing scar expression and outcome have long been defined. Although these were relatively clear\\u000a at the time, the exact events at a molecular level were poorly defined. The past decade has delineated the myriad of events\\u000a that occur in the run-up to scar evolution far more clearly, although the intricate details have yet to be elucidated. What
Alan D. Widgerow
Keratoacanthoma centrifugum marginatum (KCM) is a rare variant of keratoacanthoma (KA). It is characterized by a progressive peripheral expansion and central healing leaving atrophic scar. It is sometimes confused with squamous cell carcinoma (SCC) both clinically and histopathologically. We here report a case of KCM over the extensor aspect of the right forearm in a 57-year-old man with an abnormal looking scar.
Nag, Falguni; Biswas, Projna; Singha, Joydeep; Ghosh, Arghyaprasun; Surana, Trupti V.
Skin expansion in burn patients can be a useful method for secondary skin resurfacing, scar revision or facial remodelling. However, complications and problems occur more often in these patients than in any other. In this paper the incidence of complication in the first and second stages of expansion will be presented. Several rules will then be stated and we will
Capsular contracture remains a challenging complication of implant-based aesthetic breast surgery despite improvements in implant design. The lowering of capsular contracture rates noted with the past use of polyurethane foam-covered implants has increased awareness of the importance of the biologic response at the interface between the implant surface and breast tissue. Emerging evidence indicates that much like the polyurethane foam, acellular dermal matrices alter the biologic response at the surface interface, resulting in a more vascular and less constrictive pattern of collagen deposition. This study reports on the authors' clinical experience using Strattice Reconstructive Tissue Matrix (LifeCell Corporation, Branchburg, N.J.) for the treatment of capsular contracture in patients with established capsules and for prevention in patients undergoing primary augmentation or augmentation/mastopexy. Of 80 patients (154 breasts) in whom Strattice was used, clinically significant contracture (Baker grade III/IV) occurred in three breasts (3.75 percent), all of which were in the treatment of previous contracture group. In addition, the authors noted two seromas requiring implant removal (both patients developed capsules, as mentioned above) and two hematomas requiring revision, for an overall failure rate of 6.25 percent for Strattice-assisted surgery. The data confirm that the use of Strattice significantly lowers the incidence of capsular contracture in the first 3.5 years after implant placement. PMID:23096962
Hester, T Roderick; Ghazi, Bahair H; Moyer, Hunter R; Nahai, Farzad R; Wilton, Melissa; Stokes, Lou
Hypertrophic scars occur following cuta- neous wounding and result in severe functional and esthetic defects. The pathophysiology of this process remains unknown. Here, we demonstrate for the first time that mechanical stress applied to a healing wound is sufficient to produce hypertrophic scars in mice. The resulting scars are histopathologically identical to hu- man hypertrophic scars and persist for more
Shahram Aarabi; Kirit A. Bhatt; Yubin Shi; Josemaria Paterno; Edward I. Chang; Shang A. Loh; Jeffrey W. Holmes; Michael T. Longaker; Herman Yee; Geoffrey C. Gurtner
Understanding burns means knowing what is necessary for the successful treatment of burns. Nobody in science, economics, or quality control can comprehend this issue's complexity without thorough documentation of the work involved. BurnCase 3D is a non-profit research project whose aim, achieved through software of the same name, is a thorough and accurate burn-treatment documentation schema, facilitated by three-dimensional digital models tracked over time. Adapting these models on the basis of gender, height, weight, and body shape avoids systemic errors. Superimposing photos of the burned areas on the model prevents individual error and can be combined with methods of burn-depth evaluation. The program includes automatic encoding of diagnostic and therapeutic procedures. Model resolution is 1cm(2) and finer, so that even small scars' locations and extents can be documented, thus enabling registration of long-term results. The program's status as a multilingual data-collection tool brings together multiple international efforts in data collection, and makes it suitable for e-medicine and disaster relief. In its basic form, it provides essential functions in burn documentation, photo documentation, and reporting. The four-dimensional database allows registration of interactions over time and can demonstrate the influence of location, timing, and intervention on outcome. PMID:18950947
Haller, H L; Dirnberger, J; Giretzlehner, M; Rodemund, C; Kamolz, L
Twenty five consecutive Saudi patients who underwent treatment of hypertrophic scars using Cica-care silicone gel sheets were included. The scars were secondary to burns or traumatic friction injuries. There were 15 females and 10 males with a mean age of nine years. Patients were given detailed instructions in applying and washing the gel and attended a review clinic regularly. At each visit, problems and scar assessment using the Vancouver scale were documented by an experienced occupational therapist. Problems associated with gel sheeting were common and included persistent pruritus (80%), skin breakdown (8%), skin rash (28%), skin maceration (16%), foul smell from the gel (4%), poor durability of the sheet (8%), failure of the sheet to improve hydration of dry scars (52%), poor patient compliance (12%) and poor response of the scar to treatment (24%). Most of these problems were eliminated by temporary interruption of treatment, more frequent washings of the gel sheet, better skin hygiene and occasionally by changing the brand of gel sheets. Permanent discontinuation of treatment occurred in only one patient and was because of lack of response to treatment. The modes of action of silicone gel in the treatment of hypertrophic scars are discussed. PMID:11451605
Nikkonen, M M; Pitkanen, J M; Al-Qattan, M M
Mario Andretti, look out You are about to be surpassed in the burning rubber category by a joint venture between Oxford Energy Company and General Electric. The two companies are building the first whole tire-to-energy facility in the US in Modesto, California. This $41 million facility does not require tires to be shredded prior to incineration; it has the capacity to burn 700 tires per minute. The electricity generated will be provided to a utility company. Oxford says there are two billion waste tires on the ground and this number is increasing by 220 million a year. Of that amount, only 18 million a year are recycled.
Background. Onion extracts have been shown in vitro to accelerate wound healing. Results from clinical studies on surgical scars in Caucasians were disappointing. The aim of this study is to evaluate the effectiveness of onion extract gel in improving the cosmetic and symptoms of surgical scars in Asians. Patients/Methods. Twenty Asians who had new Pfannenstiel's cesarean section scars were recruited in this prospective double-blinded, split-scar study. Each side was randomly assigned treatment with onion extract gel or placebo at 7 days after surgery. The product was applied three times daily for 12 weeks. Subjects were evaluated at baseline and 4th and 12th weeks. Scar redness was assessed by calorimeter, scar height and pliability were assessed by blinded investigators, and scar symptoms and overall cosmetic improvement were assessed by subjects. Results. Sixteen subjects completed the study. A statistically significant difference between two sides of scar in terms of scar height and scar symptoms was found. There was no statistically significant difference in scar redness, scar pliability, and overall cosmetic appearance between two sides. Conclusions. The early use of topical 12% onion extract gel on Pfannenstiel's cesarean section scar in Asians resulted in the improvement of scar height and scar symptoms.
Chanprapaph, Kumutnart; Tanrattanakorn, Somsak; Wattanakrai, Penpun; Wongkitisophon, Pranee; Vachiramon, Vasanop
BACKGROUND: The epicanthal fold (Mongolian fold) in Asians reduces the aesthetic results of eyelid surgery, and thus, medial epicanthoplasty is commonly performed in combination with a double fold operation or blepharoptosis correction. Epicanthoplasty is one of the most popular cosmetic operations conducted in Asia, but scarring is a common problem. METHODS: From December of 2006 to July of 2011, we treated 60 cases using our epicanthoplasty method, which was designed to reduce scarring. A double fold operation and blepharoptosis correction was performed along with epicanthoplasty in 54 cases and an epicanthoplasty without a double fold operation in the remaining 6 cases. Follow-up periods ranged from 6 months to 4 years and 10 months. Previously, we used an elliptical excision epicanthoplasty method, which was simple and practical. However, the elliptical excision method leaves a vertical scar on the nasal side of the upper and lower eyelids. To avoid this scar, we placed an additional incision parallel with the ciliary margin of the lower and/or upper eyelids. The results of epicanthoplasty were evaluated by asking the patients and the surgeon involved to allocate visual analog scale scores. RESULTS: With the exception of 1 case of hypertrophic scarring and 4 cases of undercorrection, patients were satisfied with their results. Mean patient and surgeon visual analog scale scores were 4.6 and 4.2, respectively. The advantages of the described procedure are its simplicity and the minimal scarring caused in the epicanthal area. CONCLUSIONS: This method could become an effective means of removing the Asian epicanthal fold and minimizing vertical scars. PMID:23636120
Park, Dae Hwan; Park, Sang Uk; Lee, Byung Kwon; Lee, Young Bae; Do, Eon Rok; Han, Dong Gil; Shim, Jeong Su; Lee, Yong Jig
Single slow (tonic) muscle fibres were dissected from cruralis muscles of Rana temporaria and R. esculenta. Increasing concentrations of caffeine were applied in Ringer solution, and contractures were measured isometrically. Sigmoid\\u000a caffeine concentration-response curves were obtained, the threshold value being near 1.2mmol\\/l, and maximum contractures being\\u000a obtained with 10 to 20 mmol\\/1 concentrations of caffeine. Contracture solutions were modified by
C. Hoock; J. Steinmetz; H. Schmidt
The effect of zinc ions on caffeine-induced contracture in vascular smooth muscle and skeletal muscle of rat was studied. In aortic strips, caffeine contracture was depressed by Zn2+ in a dose-dependent manner. Moreover, the extent of the depression of caffeine contracture in the Zn2+ loaded smooth muscle increased with repetitive caffeine exposures. For instance, in the preparations perfused with a
Xiao-Yang Cheng; Ke-Ying Chen; Xiao-Hui Zhang; Pei-Hong Zhu
K+ contractures of tonic bundles from cruralis muscle of the frog were studied with different K+ concentrations (10-120 mM). K+ contractures had an initial transient phase followed by a sustained tension. The amplitude of the sustained tension diminished with high K+ concentration (80-120 mM). However, in all cases, tension was maintained for several minutes. External Ca2+ reduction practically abolished the sustained phase of the K+ contractures. The initial phase was also reduced and tension spontaneously relaxed. The curve relating the peak tension with log [K+]o, showed that the threshold was not affected but the peak tension was reduced to about 70% in low-Ca2+ saline (0 Ca2+ + 3 mM-Mg2+) and 50% in Ca2+-free saline (1 mM-EGTA + 3 mM-Mg2+). The dependence of the sustained tension on external Ca2+ was further confirmed by Ca2+ withdrawal and re-establishment and/or by Ni2+ substitution for Ca2+ before or during K+ contractures. These results indicate that external Ca2+ had to be continuously present to maintain the tension during K+ contractures and that Ni2+ was not able to restore the normal temporal course of K+ contracture. The sustained phase was diminished by blocking agents of Ca2+ channels, such as nifedipine (1 microM) and diltiazem (1-10 microM). The present results can be explained by a direct control of the Ca2+ currents on K+ contracture or by specific interactions between external Ca2+ and Ca2+-binding sites in the membrane.
Huerta, M; Muniz, J; Stefani, E
A hydration and occlusion treatment using Blenderm adhesive tape on the grafted skin of the burned hands and fingers or after\\u000a release of burn scar contracture of young children is described. In order to prevent scar contracture and pigmentation of\\u000a grafted skin after surgery, the application of Blenderm proves effective without the use of a splint. Observed two years after
Y. Sawada; Y. Nihei; S. Urushidate
The Transparent Face Orthosis (TFO) is widely used in the treatment of facial burns to minimize hypertrophic scarring and maintain the contours of the face against deforming scars. Compression of the TFO is achieved with forces provided by the harness system (straps and anchors) used to secure the TFO on the face. A variety of harness system designs are used clinically yet none have been described or compared in the literature. The purpose of this study was to compare seven common methods of TFO harnessing including cost, time, and ease of fabrication. Results showed that harness systems vary in cost from $0.22 to 96.45 and take 2-49min to fabricate. The 4-point harness was the least expensive and the easiest harness to fabricate. The Beanie Cap harness was the most complex system to make, while the Open Mask Stabilizer was the most expensive. The systems resulted in varying distributions of compression when depicted with three-dimensional laser scanned images. This description and comparison of fabrication materials and methods for TFO harnessing can guide clinicians within the burn community worldwide who have varying skills and resources for facial scar management. PMID:23265280
Parry, Ingrid; Hanley, Cheryl; Niszczak, Jonathan; Sen, Soman; Palmieri, Tina; Greenhalgh, David
There has never been any doubt about the importance of Robert Burns for James K. Baxter: the Scottish poet's ancestral, poetic, political and sexual inspirations and provocations appear everywhere across the range of Baxter's writing and it is a critical commonplace to note affinity and identification. At the same time it is curious to note how this debt is so
Various conditions of the oral mucosa can give rise to a burning sensation. Candidosis, geographic tongue (erythema migrans), mucocutaneous conditions and stomatitis can all cause mouth burns with visible changes to the oral mucosa. The so-called 'burning-mouth syndrome' (BMS) is a fairly rare but extremely unpleasant condition characterised by a bilateral burning sensation of the oral mucosa in the absence of clinically visible mucosal changes. Frequently-associated symptoms include dry mouth and loss or change of taste. The aetiology is unknown, even though most of the literature focuses on the role of a possible underlying psychogenic disorder. Several mucosal disorders can cause symptoms similar to BMS. Therefore, careful oral examination is required before establishing the diagnosis of BMS. Additional laboratory tests or a specialist examination rarely yield abnormal findings of relevance. Reassurance and understanding are important keywords in the management of patients suffering from BMS. Unless clearly indicated dental or medical treatment should be avoided, even if the patient insists on it, since such treatment is rarely effective. PMID:15932134
van der Waal, I
Keloids and hypertrophic scars are both abnormal wound responses in predisposed individuals but they differ in that keloids extend beyond the original wound and almost never regress, while hypertrophic scars remain within the original wound and tend to regress. How keloids grow is not totally clear because there is no animal model; in fact, keloids affect only humans. Different injuries can result in keloids, including burns, surgery, ear piercing, lacerations, abrasions, tattooing, vaccinations, injections, insect bites and any process causing skin inflammation (chicken pox, acne, folliculitis, zoster). Skin or wound tension is considered a critical factor in the formation of keloids and hypertrophic scars. This study is based on eight consecutive patients (four females and four males, F:M = 1:1) with a total of 12 keloids. All of whom were treated monthly with a MiXto SX CO(2) laser, using 13 W of power, 8 SX of index and 40% coverage (density) in combination with Same Plast Gel(®) twice a day. Each scar required 12 treatments, and all the patients, followed up for 1 year after the last treatment, had optimum results and no recurrence. PMID:20825256
Scrimali, Luca; Lomeo, Giuseppe; Nolfo, Corrado; Pompili, Gianluca; Tamburino, Serena; Catalani, Alexei; Siragò, Paolo; Perrotta, Rosario Emanuele
Early gestation fetal wounds heal without scar formation. Understanding the mechanism of this scarless healing may lead to new therapeutic strategies for improving adult wound healing. The aims of this study were to develop a human fetal wound model in which fetal healing can be studied and to compare this model with a human adult and scar tissue model. A burn wound (10 x 2 mm) was made in human ex vivo fetal, adult, and scar tissue under controlled and standardized conditions. Subsequently, the skin samples were cultured for 7, 14, and 21 days. Cells in the skin samples maintained their viability during the 21-day culture period. Already after 7 days, a significantly higher median percentage of wound closure was achieved in the fetal skin model vs. the adult and scar tissue model (74% vs. 28 and 29%, respectively, p<0.05). After 21 days of culture, only fetal wounds were completely reepithelialized. Fibroblasts migrated into the wounded dermis of all three wound models during culture, but more fibroblasts were present earlier in the wound area of the fetal skin model. The fast reepithelialization and prompt presence of many fibroblasts in the fetal model suggest that rapid healing might play a role in scarless healing. PMID:20412555
Coolen, Neeltje A; Schouten, Kelly C W M; Boekema, Bouke K H L; Middelkoop, Esther; Ulrich, Magda M W
Summary Burn sequelae used to be treated with skin grafts and local or distant flaps with a high morbidity on the donor site. The purpose of treatment today by skin expansion is to achieve aesthetic amelioration, as the advantage of this technique is that it becomes possible to obtain local flaps with the same characteristics of colour, texture, hair, and sensitivity as normal skin. This is a review of 14 cases of burn patients treated between 2006 and 2010 at our burn centre at Jeitawe Hospital, Lebanon. The patients’ ages ranged from 6 to 50 yr. The regions expanded were the scalp, forehead, neck, trunk, and the upper and lower limbs. The implants were positioned on the fascial layer; antibiotics and drainage were routinely used. The inflation of the expander began two weeks after surgery and continued for an average time of three months. Complications were rare. Results were good with an improvement of scars and minimal morbidity. Fifty per cent of our patients underwent another expansion.
Ghanime, G.; Rizkallah, N.; Said, J.M.
Local burn wound care represents an integral part in the treatment of burn victims. A primary treatment goal is to prevent superficial infections, which can lead to life-threatening bacteraemia and sepsis. Secondary goals include improvement of functional and aesthetic outcome of the regenerating skin or scar tissue. Within the last few years numerous innovations have been evolved and some have already been incorporated into the clinical routine. In line with this, the first mid-term studies can be found in the literature. For instance, a hydrosurgical system can now be used for debridement and novel skin substitutes like Suprathel and Matriderm are commercially available. This review article summarises the most recent innovations in local burn wound care and puts them into a scientific perspective. PMID:19051160
Behr, B; Megerle, K O; Germann, G; Kloeters, O
We present experimental studies of the propagation of a reaction front in a fluid flow composed of a chain of alternating vortices. We propose that the tools used to describe the transport of a passive impurity in a flow can be expanded to account for the behavior of a reaction front. In particular, we propose that motion of a reaction front from one region to another in the flow is determined by burning manifolds and burning lobes. These ideas are tested experimentally for both the time-independent and time-dependent vortex chain. For a time-independent flow, the time that it takes for a triggered reaction to propagate from one vortex to the next is the minimum time ? for the stable burning manifold BS(?) to envelope the original trigger point. For a time-dependent (oscillatory) vortex chain, we use the burning manifold/lobe framework to explain mode-locking behavior seen in earlier studies.ootnotetextM.S. Paoletti and T.H. Solomon, Europhys. Lett. 69, 819 (2005); Phys. Rev. E 72, 046204 (2005).
Kingsbury, Mark; Solomon, Tom
Objective To characterize the tissue and cellular changes found in trachomatous scarring (TS) and inflammation using in vivo confocal microscopy (IVCM). Design Two complimentary case-control studies. Participants The first study included 363 cases with TS (without trichiasis), of whom 328 had IVCM assessment, and 363 control subjects, of whom 319 had IVCM assessment. The second study included 34 cases with trachomatous trichiasis (TT), of whom 28 had IVCM assessment, and 33 control subjects, of whom 26 had IVCM assessment. Methods All participants were examined with ×2.5 loupes. The IVCM examination of the upper tarsal conjunctiva was carried out with a Heidelberg Retina Tomograph 3 with the Rostock Cornea Module (Heidelberg Engineering GmbH, Dossenheim, Germany). Main Outcome Measures The IVCM images were graded in a masked manner using a previously published grading system evaluating the inflammatory infiltrate density; the presence or absence of dendritiform cells (DCs), tissue edema, and papillae; and the level of subepithelial connective tissue organization. Results Subjects with clinical scarring had a characteristic appearance on IVCM of well-defined bands and sheets of scar tissue visible. Similar changes were also seen in some clinically normal subjects consistent with subclinical scarring. Scarred subjects had more DCs and an elevated inflammatory infiltrate, even after adjusting for other factors, including the level of clinical inflammation. Cellular activity was usually seen only in or just below the epithelium, rarely being seen deeper than 30 ?m from the surface. The presence of tissue edema was strongly associated with the level of clinical inflammation. Conclusions In vivo confocal microscopy can be quantitatively used to study inflammatory and scarring changes in the conjunctiva. Dendritic cells seem to be closely associated with the scarring process in trachoma and are likely to be an important target in antifibrotic therapies or the development of a chlamydial vaccine. The increased number of inflammatory cells seen in scarred subjects is consistent with the immunopathologic nature of the disease. The localization of cellular activity close to the conjunctival surface supports the view that the epithelium plays a central role in the pathogenesis of trachoma. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Hu, Victor H.; Weiss, Helen A.; Massae, Patrick; Courtright, Paul; Makupa, William; Mabey, David C.W.; Bailey, Robin L.; Burton, Matthew J.
To fully understand the carbon (C) cycle impacts of forest fires, both C emissions during the fire and post-disturbance fluxes need to be considered. The latter are dominated by soil surface CO2 flux (Fs), which is still subject to large uncertainties. Fire is generally regarded as the most important factor influencing succession in the boreal forest biome and fire dependant species such as jack pine are widespread. In May 2007, we took concurrent Fs and soil temperature (Ts) measurements in boreal jack pine fire scars aged between 0 and 59 years since fire. To allow comparisons between scars, we adjusted Fs for Ts (FsT) using a Q10 of 2. Mean FsT ranged from 0.56 (± 0.30 sd) to 1.94 (± 0.74 sd) ?mol CO2 m-2 s-1. Our results indicate a difference in mean FsT between recently burned (4 to 8 days post fire) and non-burned mature (59 years since fire) forest (P < 0.001), though no difference was detected between recently burned (4 to 8 days post fire) and non-burned young (16 years since fire) forest (P = 0.785). There was a difference in mean FsT between previously young (16 years since fire) and intermediate aged (32 years since fire) scars that were both subject to fire in 2007 (P < 0.001). However, there was no difference in mean FsT between mature (59 years since fire) and intermediate aged (32 years since fire) scars that were both subjected to fire in 2007 (P = 0.226). Furthermore, there was no difference in mean FsT between mature (59 years since fire) and young scars (16 years since fire) that were both subjected to fire in 2007 (P = 0.186). There was an increase in FsT with time since fire for the chronosequence 0, 16 and 59 years post fire (P < 0.001). Our results lead us to hypothesise that the autotrophic:heterotrophic soil respiration ratio increases over post-fire successional time in boreal jack pine systems, though this should be explored in future research. The results of this study contribute to a better quantitative understanding of Fs in boreal jack pine fire scars and will facilitate meta-analyses of Fs in fire scar chronosequences.
Smith, D. R.; Kaduk, J. D.; Balzter, H.; Wooster, M. J.; Mottram, G. N.; Hartley, G.; Lynham, T. J.; Studens, J.; Curry, J.; Stocks, B. J.
Scarring is a significant clinical problem following dermal injury. However, scars are not a single describable entity and huge phenotypic variability is evident. Quantitative, reproducible inter-observer scar assessment is essential to monitor wound healing and the effect of scar treatments. Scar colour, reflecting the biological processes occurring within a scar, is integral to any assessment. The objective of this study was to analyse scar colour using the non-invasive Eykona(®) Wound Measurement System (the System) as compared against the Manchester Scar Scale (MSS). Three dimensional images of 43 surgical scars were acquired post-operatively from 35 patients at 3-6 months and the colour difference between the scar and surrounding skin was calculated (giving ?Lab values). The colourimetric results were then compared against subjective MSS gradings. A significant difference in ?Lab values between MSS gradings of "slight mismatch" and "obvious mismatch" (p < 0.025) and between "obvious mismatch" and "gross mismatch" (p < 0.05) were noted. The System creates objective, reproducible data, without the need for any specialist expertise and compares favourably with the MSS. Greater scar numbers are required to further clinically validate this device - however, with this potential to calculate scar length, width, volume and other characteristics, it could provide a complete, objective, quantitative record of scarring throughout the wound-healing process. PMID:23880014
Hallam, M J; McNaught, K; Thomas, A N; Nduka, C
Chlorhexidine is an antiseptic and disinfectant commonly used for surgical site preparation and cleansing. It is active against a broad spectrum of bacteria, viruses, mycobacteria, and fungi. We report 3 cases of patients with superficial partial thickness burns immediately following shoulder arthroscopic surgery with the use of a Chloraprep 26 mL applicator (2% chlorhexidine gluconate and 70% isopropyl alcohol; CareFusion, Leawood, Kansas). All 3 patients reported pain as the anesthetic waned at a localized area on the anterior arm near the axilla. Erythema and blistering were noticeable. These areas were immediately treated with irrigation and local application of ice, and subsequently with topical triple-antibiotic ointment. All 3 cases were resolved within 3 months of surgery, but noticeable scars remained. We believe a combination of chlorhexidine skin preparation, local swelling inherent to shoulder arthroscopy, and traction contributed to these postoperative complications. PMID:22530219
Sanders, Thomas H; Hawken, Samuel M
Two cases are reported of serious extravasation injuries due to parenteral nutrition in infants born at 24 and 28 weeks' gestation. Major scarring and the need for plastic surgery were prevented by using a technique of subcutaneous hyaluronidase and saline flushing. Images
Davies, J; Gault, D; Buchdahl, R
Two cases are reported of serious extravasation injuries due to parenteral nutrition in infants born at 24 and 28 weeks' gestation. Major scarring and the need for plastic surgery were prevented by using a technique of subcutaneous hyaluronidase and saline flushing. PMID:8117129
Davies, J; Gault, D; Buchdahl, R
The performance of a simple method [E. L. Sibert III, E. Vergini, R. M. Benito, and F. Borondo, New J. Phys.NJOPFM1367-263010.1088/1367-2630/10/5/053016 10, 053016 (2008)] to efficiently compute scar functions along unstable periodic orbits with complicated trajectories in configuration space is discussed, using a classically chaotic two-dimensional quartic oscillator as an illustration.
Revuelta, F.; Vergini, E. G.; Benito, R. M.; Borondo, F.
The incidence and significance of intrarenal reflux (pyelotubular backflow) occurring during micturating cystourethrography has been studied in 386 examinations on patients with vesicoureteric reflux. This phenomenon has not been observed in patients over the age of 4 years.Renal damage having the radiographic appearance of `atrophic pyelonephritic scarring' has been shown in 13 out of 20 kidneys showing intrarenal reflux. In
G. L. Rolleston; T. M. J. Maling; C. J. Hodson
Clinically, keloids are defined as scars that invade adjacent healthy tissue and are caused by tissue injury; however, the clear distinction relating keloids to wound healing or to cancer remains elusive. This study profiled protein extracts from the regions of keloid tissues to determine the activities within these different zones, and to help underpin the activities apparent within different regions of the disease. Two-dimensional gel electrophoresis, liquid chromatography mass spectrometer (LCMS) and a Mascot online database search were employed for comparative proteomic analysis between four sites in keloidal scars (KS). Out of 400 spots identified in all gels, 21 were unique to given KS sites. These were identified using LCMS and the results showed the presence of mitochondrial and structural proteins in the margin, while the top contained keratin II. Heat shock protein was the only protein present in the internal normal control and margin, while the external normal contain keratin II and the voltage-dependent anion-selective channel protein, annexin A6, plus glial fibrillary acidic protein. This work is novel since it has identified differentially expressed proteins across the tested keloidal scar sites. The presence of mitochondrial-associated proteins at the margins suggests that this is the most active part of the scar. PMID:22407076
Javad, F; Day, P J R
The use of vertical-scar breast reduction techniques is only slowly increasing, even though they have been advocated by Lassus and Lejour and are requested by patients. Possible reasons why surgeons are reluctant to use these techniques are that they are said to be more difficult to learn, they require considerable experience and intuition, and their applicability is confined to small
G. M. Beer; W. Morgenthaler; I. Spicher; V. E. Meyer
Scar formation is a potentially detrimental process of tissue restoration in adults, affecting organ form and function. During fetal development, cutaneous wounds heal without inflammation or scarring at early stages of development; however, they begin to heal with significant inflammation and scarring as the skin becomes more mature. One possible cell type that could regulate the change from scarless to
Brian C Wulff; Allison E Parent; Melissa A Meleski; Luisa A DiPietro; Megan E Schrementi; Traci A Wilgus
Plasticity of kidney cells: Role in kidney remodeling and scarring. The progression of renal scarring and the associated loss of function remains one of the main challenges in nephrology. Until recently, the glomerular and tubulointerstitial scarring processes were thought to involve primarily interactions between infiltrating inflammatory cells and resident renal cells culminating in loss of renal cells and their replacement
A. Meguid El Nahas
Purpose: To develop and evaluate a rat excised larynx model for the measurement of acoustic, aerodynamic, and vocal fold vibratory changes resulting from vocal fold scar. Method: Twenty-four 4-month-old male Sprague-Dawley rats were assigned to 1 of 4 experimental groups: chronic vocal fold scar, chronic vocal fold scar treated with 100-ng basic…
Welham, Nathan V.; Montequin, Douglas W.; Tateya, Ichiro; Tateya, Tomoko; Choi, Seong Hee; Bless, Diane M.
|Purpose: To develop and evaluate a rat excised larynx model for the measurement of acoustic, aerodynamic, and vocal fold vibratory changes resulting from vocal fold scar. Method: Twenty-four 4-month-old male Sprague-Dawley rats were assigned to 1 of 4 experimental groups: chronic vocal fold scar, chronic vocal fold scar treated with 100-ng basic…
Welham, Nathan V.; Montequin, Douglas W.; Tateya, Ichiro; Tateya, Tomoko; Choi, Seong Hee; Bless, Diane M.
Background: Capsular contracture is a common complication associated with the use of breast implants. Numerous randomized controlled trials addressing the efficacy of textured surface breast implants in reducing capsular contracture have yielded nonuniform results. This meta-analysis addresses the use of tex- tured breast implants in the prevention of capsular contracture. Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Con-
G. Philip Barnsley; Leif J. Sigurdson; Shannon E. Barnsley
Contractures are a common complication of advanced multiple sclerosis. In consequence the care load is increased. Sitting in the wheelchair becomes difficult if not impossible and there is a high risk of pressure sores due to inadequate weight distribution. The greatest impedance to care and maintenance was thought to be the bilateral knee flexion contractures and unilateral hip adduction contracture
Pauline M Pope; Christine E Bowes; Maureen Tudor; Brian Andrews
Two families are presented, each with two affected sibs, all four of whom seem to have a newly described and specific form of congenital contractures (arthrogryposis). The affected subjects have congenital torticollis, dysmorphic, asymmetrical, myopathic facial features, and progressive scoliosis. Two sibs had cleft palate. Malignant hyperthermia has occurred in two of the patients. Images
Froster-Iskenius, U G; Waterson, J R; Hall, J G
Objective: To study the effects of electrical stimulation (ES) on flexion contractures in the hemiplegic wrist.Design: The investigation was carried out following an OFF (two weeks with rehabilitation only) - ON (two weeks with ES treatment and rehabilitation) - OFF (two weeks rehabilitation only) fixed protocol.Setting: A stroke ward and an outpatient stroke service.Subjects: Eleven hemiplegic subjects with reduced range
AD Pandyan; MH Granat; DJ Stott
Background: A study was undertaken to investigate long-term histological changes in the environment of breast implants and their correlation with complains at the time of capsular contracture defined by the Baker score.Method: The collagenous capsules of 53 silicone breast implants from 43 patients (23 smooth and 30 textured devices) were evaluated histologically for capsular thickness, the presence of histiocytes, the
Wulf Siggelkow; Andre Faridi; Katrin Spiritus; Uwe Klinge; Werner Rath; Bernd Klosterhalfen
In order to reexamine the possible association between bacterial presence and capsular contracture, 55 silicone devices (mammary implants or tissue expanders) were cultured at the time of their removal from 40 patients. Special culture techniques were used in an attempt to recover bacteria adhering to the smooth-surfaced implant and encased in glycocalyx biofilm. Bacteria were detected on 56% (15 of
Charles P. Virden; Marek K. Dobke; Paul Stein; C. Lowell Parsons; David H. Frank
In one case of Dupuytren's contracture the authors make an important literature review. The affection is rare with the black man but frequent in caucasian population. Its origin is therefore european. They point out alcoholism and microtrauma due to the patient's antecedents and job. PMID:2175829
Richard-Kadio, M; Guedegbe, F; Dick, R; Keli, E; Yapo, P; Malan, E; N'Guessan, H A; Cornet, L
Muscle diseases may have various clinical manifestations including muscle weakness, atrophy or hypertrophy and joint contractures. A spectrum of non-muscular manifestations (cardiac, respiratory, cutaneous, central and peripheral nervous system…) may be associated. Few of these features are specific. Limb joint contractures or spine rigidity, when prevailing over muscle weakness in ambulant patients, are of high diagnostic value for diagnosis orientation. Within this context, among several disorders, four groups of diseases should systematically come to mind including the collagen VI-related myopathies, the Emery-Dreifuss muscular dystrophies, the SEPN1 and FHL1 related myopathies. More rarely other genetic or acquired myopathies may present with marked contractures. Diagnostic work-up should include a comprehensive assessment including family history, neurological, cardiologic and respiratory evaluations. Paraclinical investigations should minimally include muscle imaging and electromyography. Muscle and skin biopsies as well as protein and molecular analyses usually help to reach a precise diagnosis. We will first describe the main muscle and neuromuscular junction diseases where contractures are typically a prominent symptom of high diagnostic value for diagnosis orientation. In the following chapters, we will present clues for the diagnostic strategy and the main measures to be taken when, at the end of the diagnostic work-up, no definite muscular disease has been identified. PMID:24021317
Eymard, B; Ferreiro, A; Ben Yaou, R; Stojkovic, T
Recessive mutations in FKBP10 at 17q21.2, encoding FKBP65, cause both osteogenesis imperfecta (OI) and Bruck syndrome (OI plus congenital contractures). Contractures are a variable manifestation of null/missense FKBP10 mutations. Kuskokwim syndrome (KS) is an autosomal recessive congenital contracture disorder found among Yup'ik Eskimos. Linkage mapping of KS to chromosome 17q21, together with contractures as a feature of FKBP10 mutations, made FKBP10 a candidate gene. We identified a homozygous three-nucleotide deletion in FKBP10 (c.877_879delTAC) in multiple Kuskokwim pedigrees; 3% of regional controls are carriers. The mutation deletes the highly conserved p.Tyr293 residue in FKBP65's third peptidyl-prolyl cis-trans isomerase domain. FKBP10 transcripts are normal, but mutant FKBP65 is destabilized to a residual 5%. Collagen synthesized by KS fibroblasts has substantially decreased hydroxylation of the telopeptide lysine crucial for collagen cross-linking, with 2%-10% hydroxylation in probands versus 60% in controls. Matrix deposited by KS fibroblasts has marked reduction in maturely cross-linked collagen. KS collagen is disorganized in matrix, and fibrils formed in vitro had subtle loosening of monomer packing. Our results imply that FKBP10 mutations affect collagen indirectly, by ablating FKBP65 support for collagen telopeptide hydroxylation by lysyl hydroxylase 2, thus decreasing collagen cross-links in tendon and bone matrix. FKBP10 mutations may also underlie other arthrogryposis syndromes. PMID:23712425
Barnes, Aileen M; Duncan, Geraldine; Weis, Maryann; Paton, William; Cabral, Wayne A; Mertz, Edward L; Makareeva, Elena; Gambello, Michael J; Lacbawan, Felicitas L; Leikin, Sergey; Fertala, Andrzej; Eyre, David R; Bale, Sherri J; Marini, Joan C
An investigation has been made of the putative direct myocardial protective effects of the a1-adrenoceptor antagonists, prazosin and WB 4101, against tetanic contractures of rat isolated left atria following modified Na+ channel function and consequent Ca2+ loading elicited by veratrine.
Bruno Le Grand; Aline Marty; Sylvie Vieu; Jean-Michel Talmant; Gareth W. John
Background: The in vitro contracture test (IVCT) is the golden standard to diagnose malignant hyperthermia susceptibility (MHS). A high reproducibility is important for a high validity of a test. Methods: We have therefore analyzed IVCT in 838 patients, in- vestigated in two laboratories. Each halothane and caffeine test was performed in two muscle strips. The test results were ana- lyzed
G. ISLANDER; H. Ö RDING; D. B ENDIXEN; E. RANKLEV TWETMAN
1. Submaximal potassium-induced contractures were studied in isolated mouse hemidiaphragms (HD) and compared with extensor digitorum longus (EDL) and soleus. 2. In the HD, the contracture was triphasic: an initial small, fast phase followed by a larger slow phase, and a late phase which was seen on prolonged exposure. 3. Costal segments of the HD responded to elevated potassium with a larger fast phase, while dorsal or ventral segments produced a larger slow phase. 4. In calcium-free solution, the fast phase appeared to be unaffected, while the slow phase was potentiated and its time course abbreviated. The late phase was greatly attenuated or abolished. 5. In the soleus, but not the EDL muscle, contracture amplitude in calcium-free solution was potentiated and the time course was shortened. 6. The characteristics of potassium-induced contractures of both the soleus and EDL muscles are to be seen in the response of the hemidiaphragm, but there is a regional variation in their proportional contribution which suggests a heterogeneity in diaphragm composition. PMID:2856046
Singh, Y N; Dryden, W F
We describe a male neonate with severe arachnodactyly, hypermobility of the fingers, flexion contractures of elbows, wrists, hips, and knees, micrognathia, crumpled ears, rockerbottom feet, loose redundant skin, and ocular abnormalities. Severe cardiac valve insufficiency and aortic dilatation resulted in cardiac failure and death 20 hours after birth. This case represents the severe end of the clinical spectrum of Marfan
I M Buntinx; P J Willems; S E Spitaels; P J Van Reempst; A M De Paepe; J E Dumon
Background: The etiology of elbow flexion contracture in children with brachial plexus birth palsy remains unclear. We hypothesized that the long head of the biceps brachii muscle assists with shoulder stabilization in children with brachial plexus birth palsy and that overactivity of the long head during elbow and shoulder activity is associated with an elbow flexion contracture. Methods: Twenty-one patients with brachial plexus birth palsy-associated elbow flexion contracture underwent testing with surface electromyography. Twelve patients underwent repeat testing with fine-wire electromyography. Surface electrodes were placed on the muscle belly, and fine-wire electrodes were inserted bilaterally into the long and short heads of the biceps brachii. Patients were asked to perform four upper extremity tasks: elbow flexion-extension, hand to head, high reach, and overhead ball throw. The mean duration of muscle activity in the affected limb was compared with that in the contralateral, unaffected limb, which was used as a control. Three-dimensional motion analysis, surface dynamometry, and validated function measures were used to evaluate upper extremity kinematics, elbow flexor-extensor muscle imbalance, and function. Results: The mean activity duration of the long head of the biceps brachii muscle was significantly higher in the affected limb as compared with the contralateral, unaffected limb during hand-to-head tasks (p = 0.02) and high-reach tasks (p = 0.03). No significant differences in mean activity duration were observed for the short head of the biceps brachii muscle between the affected and unaffected limbs. Isometric strength of elbow flexion was not significantly higher than that of elbow extension in the affected limb (p = 0.11). Conclusions: Overactivity of the long head of the biceps brachii muscle is associated with and may contribute to the development of elbow flexion contracture in children with brachial plexus birth palsy. Elbow flexion contracture may not be associated with an elbow flexor-extensor muscle imbalance, as previously hypothesized. The negative impact of elbow flexion contracture on upper extremity function warrants future research in the development of preventive and therapeutic techniques to address elbow flexion contractures in children with brachial plexus birth palsy. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Sheffler, Lindsey C.; Lattanza, Lisa; Sison-Williamson, Mitell; James, Michelle A.
The prevalence of radial scar (RS) is 0.04% in asymptomatic women participating in population screening for breast cancer.\\u000a It is important to differentiate RS from concomitant malignancies, which occur in 20–30% of patients, or from small stellate\\u000a carcinomas which give similar radiomorphology. The aim of our study was to evaluate the effectivity of current breast diagnostic\\u000a methods in distinguishing between
Zsófia Egyed; Zoltán Péntek; Balázs Járay; Janina Kulka; Egon Svastics; József Kas; Zsolt László
Umbilical scarring is the presence of excess scar tissue deposited between abdominal dermal layers at the site of yolk sac absorption in hatchling American alligators (Alligator mississippiensis). The presence of this dermal condition plays a key evaluatory role in the overall quality and subsequent value for various commercial leather products. Despite the prevalent nature of this condition, currently the industry has no standardized protocols for its quantification. The objectives of this study were to examine the relationship between hatchling weight and age and incidence of umbilical scarring and to develop a quantifiable and reproducible technique to measure this dermal condition in hatchling American alligators. Thirty eggs from each of nine clutches were incubated in two separate incubators at different facilities and hatchling umbilical scarring was measured at 2 and 10 days of age using digital calipers. Umbilical area was calculated by multiplying umbilical length times umbilical width. There was a significant effect of both age and clutch on umbilical area (overall decline of 64%) by 10 days post-hatch. However, only five of the nine clutches utilized expressed a noticeable decline in the size of this dermal condition (range 67-74%). We had hypothesized that larger hatchlings would have larger umbilical areas and a slower rate of improvement in this condition during the first few days post-hatch. The differences in umbilical area and percent decline with age across clutches, however, were not associated with differences in initial hatchling weights. Within clutches and time periods, hatchling weight had no significant effect on the size and/or rate of decline of this condition. ?? 2004 Published by Elsevier B.V.
Wiebe, J. J.; Sepulveda, M. S.; Buckland, J. E.; Anderson, S. R.; Gross, T. S.
Painful adductor muscle contracture is an important cause of failure during rehabilitation following total hip arthroplasty (THA). Adductor muscle contracture may be caused by postoperative muscle retractions, adhesive capsulitis, postoperative leg-length inequalities caused by implant failure, or preexisting hip pathologies. A 34-year-old woman experienced a persistent painful contracture into the left adductor magnus muscle after THA. She had no leg-length inequalities and, according to the Medical Research Council scale (grades 0-5), muscle strength of the quadriceps was 5/5 for the right side and 3/5 for the left. The degree of functionality according to the Harris hip score (HHS) was 16/100 in the left hip. The pain level, measured with the visual analog scale (VAS), was 7/10. The patient was unable to fully adhere to the rehabilitation program and walked with a limp during the stance phase of gait. After 7 days of treatment with injections of botulinum toxin type A into the left adductor magnus muscle (dose, 150 UM) and subsequent rehabilitation, a great reduction of painful contracture was observed (VAS score, 2/10). The procedure was well tolerated and no adverse effects were noted. After 20 days, hip articular range of motion and gait had improved (HHS score, 75/100). The clinical effects of botulinum toxin type A were present at 2-month follow-up. This treatment may be a viable alternative for the management of painful adductor muscle contracture after THA, without significant side effects. PMID:19824593
Santamato, Andrea; Ranieri, Maurizio; Panza, Francesco; Solfrizzi, Vincenzo; Frisardi, Vincenza; Lapenna, Luisa Maria; Moretti, Biagio; Fiore, Pietro
The relations between ATP depletion, increased cytosolic free calcium concentration [( Cai]), contracture development, and lethal myocardial ischemic injury, as evaluated by enzyme release, were examined using 19F nuclear magnetic resonance to measure [Cai] in 1,2-bis(2-amino-5-fluorophenoxy)ethane-N,N,N',N'-tetraacetic acid (5F-BAPTA)-loaded perfused rat hearts. Total ischemia at 37 degrees C was induced in beating hearts, potassium-arrested hearts, magnesium-arrested hearts, and hearts pretreated with 0.9 microM diltiazem to reduce but not abolish contractility. In the beating hearts, time-averaged [Cai], which is intermediate between the systolic and the basal [Cai], was 544 +/- 74 nM. In contrast, in the potassium- and magnesium-arrested hearts, the time-averaged values are lower than in beating hearts (352 +/- 88 nM for potassium arrest, 143 +/- 22 nM for magnesium arrest). During ischemia, ATP depletion, contracture, and a rise in [Cai] are delayed by cardiac arrest, but all occur more rapidly in the potassium-arrested hearts than in the magnesium-arrested hearts. The diltiazem-treated hearts were generally similar to the magnesium-arrested hearts in their response to ischemia. Under all conditions, contracture development was initiated after tissue ATP had fallen to less than 50% of control; invariably, there was a progressive rise in [Cai] during and following contracture development. Reperfusion with oxygenated perfusate shortly after peak contracture development resulted in a return of [Cai] to its preischemic level, resynthesis of creatine phosphate, no significant enzyme release, and no substantial loss of 5F-BAPTA from the heart. The data demonstrate that an increase in [Cai] precedes lethal myocardial ischemic injury. This rise in [Cai] may accelerate the depletion of cellular ATP and may directly contribute to the development of lethal ischemic cell injury. PMID:2295135
Steenbergen, C; Murphy, E; Watts, J A; London, R E
1. The amplitude and time course of K contractures (Cl- constant) of single twitch muscle fibres of the frog have been analysed in three external Ca2+ concentrations. 2. The resting potential, effective resistance, threshold for the Na current and K-induced depolarizations were not modified by replacing 1.8 mM-Ca2+ by 3 mM-Mg2+ in absence (low-Ca saline: 3-6 micro M-Ca2+) or in the presence of 5 mM-EGTA (Ca-free saline: less than or equal to 10(-9) M-Ca2+). 3. The tension development during the initial phase of K contractures was independent of external Ca2+ while the amplitude, the duration and the time constant of spontaneous relaxation decreased progressively as Ca2+ concentration was diminished. 4. When the concentration of Mg2+ was increased to 5 mM in Ca-free saline K contractures were slower and smaller than those in 3 mM-Mg2+. 5. In Ca-free saline the activation curve (peak tension vs. logarithm of external K+ concentration) shifted by 3-5 mV towards more positive potentials while the inactivation curve (peak tension of the test contracture vs. logarithm of external K+ concentration during the conditioning period) shifted by 16-18 mV towards more negative potentials. Both curves became steeper in Ca-free saline. 6. The effects of external Ca2+ reduction were not modified by replacing all chloride for methanesulphonate. 7. Direct effects of external Ca2+ on excitation-contraction coupling during K contractures could involve the inward Ca current and/or specific interactions between external Ca2+ ions and the coupling mechanism.
Cota, G; Stefani, E
Burn-In is used to screen weak parts from a population of completely processed chips to assist in meeting reliability requirements. This tutorial provides a general introduction to burn-in. It is shown how burn-in improves the failure rate. Typical burn-in conditions, the burn-in models and an example of failure mechanisms are given. The impact of burn-in on technology reliability (hot carriers,
Scarring in quantum systems with classical chaotic dynamics is one of the most remarkable phenomena in modern physics. Previous works were concerned mostly with nonrelativistic quantum systems described by the Schrödinger equation. The question remains outstanding of whether truly relativistic quantum particles that obey the Dirac equation can scar. A significant challenge is the lack of a general method for solving the Dirac equation in closed domains of arbitrary shape. In this paper, we develop a numerical framework for obtaining complete eigensolutions of massless fermions in general two-dimensional confining geometries. The key ingredients of our method are the proper handling of the boundary conditions and an efficient discretization scheme that casts the original equation in a matrix representation. The method is validated by (1) comparing the numerical solutions to analytic results for a geometrically simple confinement and (2) verifying that the calculated energy level-spacing statistics of integrable and chaotic geometries agree with the known results. Solutions of the Dirac equation in a number of representative chaotic geometries establish firmly the existence of scarring of Dirac fermions.
Ni, Xuan; Huang, Liang; Lai, Ying-Cheng; Grebogi, Celso
Scarring in quantum systems with classical chaotic dynamics is one of the most remarkable phenomena in modern physics. Previous works were concerned mostly with nonrelativistic quantum systems described by the Schrödinger equation. The question remains outstanding of whether truly relativistic quantum particles that obey the Dirac equation can scar. A significant challenge is the lack of a general method for solving the Dirac equation in closed domains of arbitrary shape. In this paper, we develop a numerical framework for obtaining complete eigensolutions of massless fermions in general two-dimensional confining geometries. The key ingredients of our method are the proper handling of the boundary conditions and an efficient discretization scheme that casts the original equation in a matrix representation. The method is validated by (1) comparing the numerical solutions to analytic results for a geometrically simple confinement and (2) verifying that the calculated energy level-spacing statistics of integrable and chaotic geometries agree with the known results. Solutions of the Dirac equation in a number of representative chaotic geometries establish firmly the existence of scarring of Dirac fermions. PMID:23005558
Ni, Xuan; Huang, Liang; Lai, Ying-Cheng; Grebogi, Celso
In several important biomes, including croplands and tropical forests, many small fires exist that have sizes that are well below the detection limit for the current generation of burned area products derived from moderate resolution spectroradiometers. These fires likely have important effects on greenhouse gas and aerosol emissions and regional air quality. Here we developed an approach for combining 1km thermal anomalies (active fires; MOD14A2) and 500m burned area observations (MCD64A1) to estimate the prevalence of these fires and their likely contribution to burned area and carbon emissions. We first estimated active fires within and outside of 500m burn scars in 0.5 degree grid cells during 2001-2010 for which MCD64A1 burned area observations were available. For these two sets of active fires we then examined mean fire radiative power (FRP) and changes in enhanced vegetation index (EVI) derived from 16-day intervals immediately before and after each active fire observation. To estimate the burned area associated with sub-500m fires, we first applied burned area to active fire ratios derived solely from within burned area perimeters to active fires outside of burn perimeters. In a second step, we further modified our sub-500m burned area estimates using EVI changes from active fires outside and within of burned areas (after subtracting EVI changes derived from control regions). We found that in northern and southern Africa savanna regions and in Central and South America dry forest regions, the number of active fires outside of MCD64A1 burned areas increased considerably towards the end of the fire season. EVI changes for active fires outside of burn perimeters were, on average, considerably smaller than EVI changes associated with active fires inside burn scars, providing evidence for burn scars that were substantially smaller than the 25 ha area of a single 500m pixel. FRP estimates also were lower for active fires outside of burn perimeters. In our analysis we quantified how including sub-500m burned area influenced global burned area, carbon emissions, and net ecosystem exchange (NEE) in different continental regions using the Global Fire Emissions Database (GFED) biogeochemical model. We conclude by discussing validation needs using higher resolution visible and thermal imagery.
Randerson, J. T.; Chen, Y.; Giglio, L.; Rogers, B. M.; van der Werf, G.
Laser-Assisted Skin Healing (LASH) is based on the therapeutic effects of controlled thermal post-conditioning. The authors have previously demonstrated on humans that an 810-nm diode-laser system could assist wound closure leading to an improvement of wound healing with a resulting indiscernible scar. A 47-year-old woman (skin type II), who developed systematically hypertrophic scars after surgery, was enrolled for a hypertrophic scar revision. Excess scar tissue was removed. Immediately after the conventional closure of the incision, laser irradiation (120 J/cm(2)) using a 0.8 cm(2) spot size (rectangular spot, length = 20 mm, width = 4 mm) was applied. Topical silicone gel sheeting (Cerederm((R))) was applied for 2 months afterwards to prevent a thick scar from reforming. No complications occurred during the course of this study. No recurrence of hypertrophic scarring was noticed 6 months after scar revision. This study reports, for the first time, the possibility of improving the appearance of hypertrophic scarring in scar revision by altering through thermal stress the wound-healing process. Since the appropriate initial management of wounds is of importance, the LASH technique could be offered as a new approach to prevent hypertrophic scarring. PMID:19951192
Capon, Alexandre; Iarmarcovai, Gwen; Mordon, Serge
Despite the plethora of technologic advances, the most common technique for diagnosing burn depth remains the clinical assessment of an experienced burn surgeon. It is clear that this assessment is accurate for very deep and very shallow burns. But since clinical judgment is not precise in telling whether a dermal burn will heal in 3 weeks, efforts to develop a
David Heimbach; Loren Engrav; Baiba Grube; Janet Marvin
In the United States nearly 2 million people are burned every year; about 100,000 burns are moderate to severe and require hospitalization and about 5,000 deaths occur because of burns. The overall improvement in mortality and outcome of patients with severe burn trauma over the last decades can be attributed to the following: (1) emergency medical treatment with aggressive early
David N. Herndon; Marcus Spies
Sarcoidosis is a chronic, inflammatory, multi-organ disease of unknown origin that is characterized by non-caseating granuloma formation in affected organs. Cutaneous involvement is reported in 25% of patients with sarcoidosis. Scar sarcoidosis is rare but is clinically specific for skin sarcoidosis. Systemic involvement is seen in most patients with scar sarcoidosis. We present a case of scar sarcoidosis in a 30-year-old male that developed infiltrated nodules on old scars, including on his penile shaft, which is rare, and that also had pulmonary involvement. Scar sarcoidosis should be considered in the differential diagnosis of changes in all scar areas and should be investigated for systemic involvement. PMID:24089136
Su, Ozlem; Onsun, Nahide; Topukçu, Bu?çe; Ozçelik, Hatice Kutbay; Cak?ter, Alk?m Unal; Büyükp?narba??l?, Nur
The interfacial rub phenomena between scar skin and other external surfaces are a prevalent problem in everyday life. Literature on the tribological behavior of scar skin is scarce to date. In this study, the tribological behavior and comfort sensations of residual limb scar skin, prosthetic wearing skin and healthy limb skin were investigated in vivo by using UMT-II multi-specimen Micro-Tribometer
W. Li; M. Kong; X. D. Liu; Z. R. Zhou
Atrophic facial acne scarring is a widely prevalent condition that can have a negative impact on a patient’s quality of life.\\u000a The appearance of these scars is often worsened by the normal effects of aging. A number of options are available for the\\u000a treatment of acne scarring, including chemical peeling, dermabrasion, ablative or nonablative laser resurfacing, dermal fillers,\\u000a and surgical
T. Gerald O’Daniel
Scar management for the prevention of excessive scar formation has always been important but never so important as it is today.\\u000a Optimal management continues to be an enigma for surgeons, and the best modality of treatment has been debated for many years.\\u000a However, most studies have unfortunately been either retrospective or case report descriptions. Advances in scar management\\u000a have been
Ahmed Samir Edriss; V. Smrcka
Capsular contracture around gel and gel-saline implants is the most common complication following breast augmentation and reconstruction. Thirty-one patients with postaugmentation gel-implant contractures were treated with open capsulotomy and replacement with polyurethane-covered implants. Eighty-seven percent remain soft after a minimum follow-up of 14 months. Results of replacement after subcutaneous mastectomy and reconstruction are more varied and less successful. Results in 14 patients are presented. PMID:2195568
Melmed, E P
?Cat FACE? SCAR ON LONGLEAF PINE TREE, OVERHILLS HISTORIC ENTRANCE ROAD, FACING NORTHEAST - Overhills, Fort Bragg Military Reservation, Approximately 15 miles NW of Fayetteville, Overhills, Harnett County, NC
Abnormally pigmented scars are an undesirable consequence of cutaneous wound healing and are a complication every single individual worldwide is at risk of. They present a challenge for clinicians, as there are currently no definitive treatment options available, and render scars much more noticeable making them highly distressing for patients. Despite extensive research into both wound healing and the pigment cell, there remains a scarcity of knowledge surrounding the repigmentation of cutaneous scars. Pigment production is complex and under the control of many extrinsic and intrinsic factors and patterns of scar repigmentation are unpredictable. This article gives an overview of human skin pigmentation, repigmentation following wounding and current treatment options.
Chadwick, Sarah; Heath, Rebecca; Shah, Mamta
Adenosine A2A receptor (A2AR) stimulation promotes wound healing and is required for the development of fibrosis in murine models of scleroderma and cirrhosis. Nonetheless, the role of A2AR in the formation of scars following skin trauma has not been explored. Here, we examined the effect of pharmacological blockade of A2AR, with the selective adenosine A2AR-antagonist ZM241385 (2.5 mg/ml), in a murine model of scarring that mimics human scarring. We found that application of the selective adenosine A2AR antagonist ZM241385 decreased scar size and enhanced the tensile strength of the scar. Within the scar itself, collagen alignment and composition (marked reduction in collagen 3), but not periostin, biglycan, or fibronectin accumulation, was improved by application of ZM241385. Moreover, A2AR blockade reduced the number of myofibroblasts and angiogenesis but not macrophage infiltration in the scar. Taken together, our work strongly suggests that pharmacological A2AR blockade can be used to diminish scarring while improving the collagen composition and tensile strength of the healed wound.—Perez-Aso, M., Chiriboga, L., Cronstein, B. N. Pharmacological blockade of adenosine A2A receptors diminishes scarring.
Perez-Aso, Miguel; Chiriboga, Luis; Cronstein, Bruce N.
Numerous treatment modalities are available for scar management depending upon scar characteristics, age and patient expectations. The focus of this article is to review commonly used nonsurgical methods of scar revision. These include topical applications (e.g., silicone, vitamin E, pressure dressing, herbal extracts), intralesional medication (e.g., steroids, antimitotics), soft-tissue augmentation (e.g., collagen, fat), laser applications (e.g., 585-nm flashlamp-pumped pulsed dye, CO2), cryotherapy and make-up camouflage. Nonsurgical modalities can be used as prophylactic prevention of adverse scar formation, as definitive treatment, as intervening therapy until further surgical repair can be made, or as adjunctive treatment following surgical scar revision. There are several laser systems available that permit successful treatment of various types of scars. The 585-nm PDL remains the gold standard for laser treatment of hypertrophic scars and keloids. Although atrophic scars may best be treated with ablative CO2 and Er:YAG lasers, the intense interest in procedures with reduced morbidity profiles has increased the popularity of nonablative laser procedures. This paper will focus on the use of lasers for scar revision. PMID:21061757
Elsaie, Mohamed L; Choudhary, Sonal
Study Design A prospective analysis of an adaptive change of the spinopelvic alignment after total knee arthroplasty. Purpose To evaluate the effect of correction of the contractured knee in flexion on the spinopelvic alignment by total knee arthroplasty. Overview of Literature Flexion contracture of the knee joint may affect the body posture and precipitate the symptoms in the lumbar spine, which is known as the 'knee-spine syndrome'. Methods Fifteen patients who could be followed at least over 12 months were used in this study. Neutral whole spine lateral standing radiograms taken at certain intervals were analyzed. The subjects were divided into two groups (group A, the patients who obtained over 10° correction; group B, the others). The sacral slope, the pelvic tilt and the pelvic incidence were measured preoperatively and at 12 months and thereafter postoperatively in all the patients. Also, the thoracic kyphosis, lumbar lordosis, and lumbosacral angle were measured, including the spinal sagittal balance, S1 overhang and spino-sacral angle. Results The average correction of the contractured knee in flexion were 13.8° in group A and 2.7° in group B. The median of changes of the sacral slope were 4.2° in group A and -0.4° in group B. These results revealed that there was a significant increase of the sacral slope for group A (p=0.001). However, there were no significant differences between the other parameters. Conclusions The sacral slope appears to be affected by the change of the flexion contracture after total knee arthroplasty.
Lee, Sang-Min; Yoon, Min Geun; Lee, Bong-Jin; Lee, Sung-Rak; Seo, Young Hoon
At concentrations between 1 to 10 raM, caffeine reduced the Ca-accumulating capacity of fragmented reticulum obtained from frog and rabbit muscle. With 8 mM caffeine enough Ca was released from frog reticulum to account for the force of the contracture. Caffeine did not affect all reticulum membranes equally. The fraction which was spun down at 2000 g was more sensitive
A. Weber; R. HERZ
Background Bladder neck contracture (BNC) following prostatectomy has been reported in 0.5–32% of cases. While the etiology of a BNC\\u000a is unclear, several factors have been associated with this complication, including blood loss, devascularization of bladder\\u000a neck tissue, poor mucosal apposition and urinary extravasation. To study the impact of urinary extravasation on BNC formation,\\u000a we used post-operative drain output as a
Gregory R. Hanson; Erin Odom; Lester S. Borden Jr; Nancy Neil; John M. Corman
Capsular contracture constitutes the main postoperative complication after breast augmentation by implant placement. To date,\\u000a no systemic treatment known allows for improvement that does not simultaneously put the patient at risk for secondary complications\\u000a of a more general nature. Flector Tissugel is the sole locally active antiinflammatory patch. Its durable local antiinflammatory\\u000a effect is associated only with a risk for
Claude Le Louarn; J. Buis; E. Auclair
As a major Ca2+ source for muscle contraction, the sarcoplasmic reticulum (SR) of skeletal muscle maintains its Ca2+ content by uptake of myoplasmic Ca2+ and by replenishment with extracellular Ca2+. Since transection of motor nerve alters the functions of SR Ca2+ pump and sarcolemma ion channels, this study explored the effect of denervation on the contracture evoked by cyclopiazonic acid
S. J. Hong; Hsiu-Chuan Liang; Ching-Jung Shen
The caffeine contracture test is the most commonly used method of diagnosing malignant hyperthermia. We have examined some\\u000a factors which may influence the results of this test. These have included the temperature of the bathing solution, the size\\u000a of the muscle fascicles, and the combined effect of the passage of time and prior equilibration with caffeine or with caffeine\\u000a plus
Beverley A. Britt; Laszlo Endrenyi; Elizabeth Scott; Wanda Frodis
Autosomal-dominant familial hematuria with retinal arteriolar tortuosity and contractures: A novel syndrome.BackgroundAutosomal-dominant forms of hematuria have been mostly related to mutations in the COL4A3\\/COL4A4 genes. Patients with thin basement membrane (BM) disease do not have extrarenal manifestations, while those with Alport syndrome often present with hearing loss, anterior lenticonus, and dot-and-fleck retinopathy.MethodsWe performed a phenotypic study and a candidate gene
EMMANUELLE PLAISIER; SONIA ALAMOWITCH; OLIVIER GRIBOUVAL; BÉATRICE MOUGENOT; ALAIN GAUDRIC; CORINNE ANTIGNAC; ETIENNE ROULLET; PIERRE RONCO
Scarring of the vocal folds leads to a deterioration of the highly complex microstructure with consecutively impaired vibratory pattern and glottic insufficiency. The resulting dysphonia is predominantly characterized by a reduced vocal capacity. Despite considerable progress in the understanding of the underlying pathophysiology, treatment of scarred vocal folds is still an unresolved chapter in laryngology and phonosurgery. Decisive for successful treatment is an individual, multidimensional concept that comprises the whole armamentarium of surgical and nonsurgical (e.g. voice therapy) modalities. The chosen phonosurgical method is determined by the main clinical feature: medialization techniques for treatment of glottic insufficiency, or epithelium-freeing techniques for improvement of vibration characteristics often combined with injection augmentation or implantation. In severe cases, buccal mucosa grafting can be an option. New developments include treatment with angiolytic lasers [pulse dye laser, PDL; potassium titanyl phosphate (KTP) laser], or techniques of tissue engineering. However, despite promising results with in vitro experiments, animal studies and first clinical trials, application in clinical routine has not yet been achieved. PMID:23241854
Friedrich, G; Gugatschka, M
Two moderate resolution imaging spectroradiometer (MODIS) instruments are planned for launch in 1999 and 2000 on the NASA Earth Observing System (EOS) AM-1 and EOS PM-1 satellites. The MODIS instrument will sense fires with designated 3.9 and 11 ?m channels that saturate at high temperatures (450 and 400 K, respectively). MODIS data will be used to detect fires, to estimate the rate of emission of radiative energy from the fire, and to estimate the fraction of biomass burned in the smoldering phase. The rate of emission of radiative energy is a measure of the rate of combustion of biomass in the fires. In the Smoke, Clouds, and Radiation-Brazil (SCAR-B) experiment the NASA ER-2 aircraft flew the MODIS airborne simulator (MAS) to measure the fire thermal and mid-IR signature with a 50 m spatial resolution. These data are used to observe the thermal properties and sizes of fires in the cerrado grassland and Amazon forests of Brazil and to simulate the performance of the MODIS 1 km resolution fire observations. Although some fires saturated the MAS 3.9 ?m channel, all the fires were well within the MODIS instrument saturation levels. Analysis of MAS data over different ecosystems, shows that the fire size varied from single MAS pixels (50×50 m) to over 1 km2. The 1×1 km resolution MODIS instrument can observe only 30-40% of these fires, but the observed fires are responsible for 80 to nearly 100% of the emitted radiative energy and therefore for 80 to 100% of the rate of biomass burning in the region. The rate of emission of radiative energy from the fires correlated very well with the formation of fire burn scars (correlation coefficient = 0.97). This new remotely sensed quantity should be useful in regional estimates of biomass consumption.
Kaufman, Yoram J.; Kleidman, Richard G.; King, Michael D.
In the literature no systematic study is available on rescuer burn for victims of burn injury. This is a retrospective study of nine patients (five admitted and four outpatients) were treated in this hospital as rescuer burns in 3.5 years. All nine patients were males. Average age of the patient treated on outpatient basis was 47 years (ranging between 44 and 52) and total burn area ranged for 1-4%. Average age of the five patients treated on inpatient basis was 32.6 years (ranging between 30 and 34). The total burn area ranged from 14.5 to 38%. During the period of study, in addition to nine rescuer burns, one patient sustained burn before the rescue attempt due to the victim hugging the rescuer. Based on the study of patterns of burn, these patients were found to have three grades of burn injury: Grade 1--upper extremity involvement only. (A) only one upper extremity involvement, (B) both upper extremities involvement, Grade 2--upper extremity/extremities and face involvement, Grade 3--upper extremity/extremities, face-neck, adjacent chest and lower extremity involvement. PMID:17011132
Kumar, Pramod; Gopal, Kirun; Ramnani, Sunil
Pathological cutaneous scars such as keloids and hypertrophic scars (HSs) are characterized by a diffuse redness that is caused by the overgrowth of capillary vessels due to chronic inflammation. Our group has been using long-pulsed, 1064-nm Nd:YAG laser in noncontact mode with low fluence and a submillisecond pulse duration to treat keloids and hypertrophic scars since 2006 with satisfactory results. The present study examined the efficacy of this approach in 22 Japanese patients with keloids (n = 16) or hypertrophic scars (n = 6) who were treated every 3 to 4 weeks. Treatment settings were as follows: 5 mm spot size diameter; 14 J/cm(2) energy density; 300 ?s exposure time per pulse; and 10 Hz repetition rate. The responses of the pathological scars to the treatment were assessed by measuring their erythema, hypertrophy, hardness, itching, and pain or tenderness. Moreover, skin samples from 3 volunteer patients were subjected to histological evaluation and 5 patients underwent thermography during therapy. The average total scar assessment score dropped from 9.86 to 6.34. Hematoxylin and eosin staining and Elastica Masson-Goldner staining showed that laser treatment structurally changed the tissue collagen. This influence reached a depth of 0.5 to 1 mm. Electron microscopy revealed plasma protein leakage, proteoglycan particles, and a change in the collagen fiber fascicles. Further analyses revealed that noncontact mode Nd:YAG laser treatment is highly effective for keloids and hypertrophic scars regardless of patient age, the origin and multiplicity of scarring, the location of the scar(s), or the tension on the scar. PMID:22259645
Akaishi, Satoshi; Koike, Sachiko; Dohi, Teruyuki; Kobe, Kyoko; Hyakusoku, Hiko; Ogawa, Rei
Pathological cutaneous scars such as keloids and hypertrophic scars (HSs) are characterized by a diffuse redness that is caused by the overgrowth of capillary vessels due to chronic inflammation. Our group has been using long-pulsed, 1064-nm Nd:YAG laser in noncontact mode with low fluence and a submillisecond pulse duration to treat keloids and hypertrophic scars since 2006 with satisfactory results. The present study examined the efficacy of this approach in 22 Japanese patients with keloids (n = 16) or hypertrophic scars (n = 6) who were treated every 3 to 4 weeks. Treatment settings were as follows: 5 mm spot size diameter; 14 J/cm2 energy density; 300 ?s exposure time per pulse; and 10 Hz repetition rate. The responses of the pathological scars to the treatment were assessed by measuring their erythema, hypertrophy, hardness, itching, and pain or tenderness. Moreover, skin samples from 3 volunteer patients were subjected to histological evaluation and 5 patients underwent thermography during therapy. The average total scar assessment score dropped from 9.86 to 6.34. Hematoxylin and eosin staining and Elastica Masson-Goldner staining showed that laser treatment structurally changed the tissue collagen. This influence reached a depth of 0.5 to 1 mm. Electron microscopy revealed plasma protein leakage, proteoglycan particles, and a change in the collagen fiber fascicles. Further analyses revealed that noncontact mode Nd:YAG laser treatment is highly effective for keloids and hypertrophic scars regardless of patient age, the origin and multiplicity of scarring, the location of the scar(s), or the tension on the scar.
Akaishi, Satoshi; Koike, Sachiko; Dohi, Teruyuki; Kobe, Kyoko; Hyakusoku, Hiko; Ogawa, Rei
The objective of this study was to determine whether the type of capsulectomy, anterior or total, affects the recurrence of capsular contracture around subglandular silicone-gel breast implants. A retrospective analysis was performed of patients who underwent either anterior or total capsulectomy for Baker grade 3 or 4 subglandular capsular contracture in our unit. All patients were invited to a review clinic where their capsular status was assessed. There were 100 anterior- disc capsulectomies in 60 patients between 1988 and 1997 and 99 total capsulectomies in 60 patients between 1990 and 1998. The follow-up in the former group was a median of 7 years and mean 6.9 years, compared with median 2.5 and mean 3.1 years in the latter group. Eighty-six percent of the implants removed from both groups at capsulectomy were smooth-walled gel-filled implants. Sixty-nine breasts in the anterior group received textured gel implants at capsulectomy; the remaining 31 received polyurethane-coated Meme implants. In the total capsulectomy group, all but two breasts (one patient) received textured gel implants. After review, the capsular status was known in 80 percent of the anterior and 92 percent of the total capsulectomy group. The review clinic found eight new contractures in five patients to have developed in the anterior compared with none in the total group. Recurrent contractures affected 50 percent of patients (46 percent of breasts) in the anterior and 11 percent of patients (10 percent of breasts) in the total capsulectomy group. Kaplan-Meier survival analysis was applied to the data. By including only patients who received textured gel implants at capsulectomy, the Logrank found a statistical difference between the two treatment groups (0.01 < p < 0.5). We believe that this study provides some evidence that total capsulectomy for subglandular silicone breast implant capsular contracture results in a lower capsular recurrence than anterior- disc capsulectomy. The pattern and risk of recurrence after total capsulectomy and exchange for a modern textured prosthesis appear to approach those following primary augmentation. PMID:11007390
Collis, N; Sharpe, D T
1. The effect of adrenaline on contracture and twitch tension in frog's ventricle has been examined, using the superfused preparation. 2. In 1 mM-Ca Ringer, contractures induced with excess KCl concentrations from 50 to 200 mM, are reduced by 1 × 10-6 g/ml. adrenaline to an average of 0·62 of control values, in marked contrast to the well known positive inotropic effect of adrenaline on the heart twitch. This effect of adrenaline is directly dose dependent. Increasing [Ca]o diminishes the effect of adrenaline on contracture tension, and on the twitch tension. 3. Adrenaline has a significantly greater effect on the KCl contracture tension than noradrenaline or isoprenaline. 4. In 1 mM-Ca Ringer, Na-free contractures are reduced to 0·72 of controls by 1 × 10-6 g/ml. adrenaline. Adrenaline also significantly reduces tension in contractures induced by 50 c/s alternating current. 5. The action of adrenaline on contracture tension is largely complete in 1-2 min at various rates of stimulation and calcium concentrations. A similar time course has been found for the effect of adrenaline on membrane potential. 6. Pronethalol blocks the action of adrenaline on both twitch and contracture. The action on the contracture can also be blocked by ouabain (1 × 10-5 M), and exposure of the tissue to K-free or Na-free Ringer solution. 7. Adrenaline hyperpolarizes the membrane potential with a range of [K]o from 0 to 200 mM. This effect is blocked by pronethalol and ouabain. After exposure to ouabain, adrenaline causes a significant decrease in the membrane potential. This may be due to an increase in the sodium permeability. 8. At low values of the [Ca]/[Na]2 ratio, adrenaline takes a relatively constant number of beats for full action, but at high values of the ratio the development of full effect is largely time dependent. 9. The time course of the effect on the twitch of changing from 0·5 to 2 mM-Ca Ringer has been studied at various rates of stimulation. The equilibration time has been found to depend on the heart rate. 10. The effect on the contracture suggests that adrenaline decreases the calcium permeability. It is further suggested that the development of twitch tension is not due to direct Ca entry but is due to the release of Ca from a local store within or between the cells. The inotropic action of adrenaline is explained in terms of this store.
Graham, J. A.; Lamb, J. F.
Burn injury is associated with disabling scar formation which impacts on many aspects of the patient's life. Previously we have shown that the fetus heals a deep dermal burn in a scarless fashion. Amniotic membrane (AM) is the outermost fetal tisue and has beeen used as a dressing in thermal injuries, though there is little data to support this use. To assess the efficacy of AM in scar minimisation after deep dermal burn wound, we conducted a randomised controlled study in the 1-month lamb. Lambs were delivered by caesarian section and the amniotic membranes stored after which lambs were returned to their mothers post-operatively. At 1 month, a standardised deep dermal burn was created under general anaesthesia on both flanks of the lamb. One flank was covered with unmatched AM, the other with paraffin gauze. Animals were sequentially euthanased from Day 3-60 after injury and tissue analysed for histopathology and immunohistochemically for alpha-smooth muscle actin (alphaSMA) content. AM resulted in reduced scar tissue as assessed histopathologically and reduced alphaSMA content. This study provides the first laboratory evidence that AM may reduce scar formation after burn injury. PMID:19447551
Fraser, John F; Cuttle, Leila; Kempf, Margit; Phillips, Gael E; Hayes, Mark T; Kimble, Roy M
Background: Depressed scars in the neck pose a cosmetic problem. There is a need to fill the lost tissue volume defect between the surface and deeper tissues. It is preferable that the filling is done by autologous tissue which is available in substantial amount in the adjoining area. There should be no donor site morbidity. Platysma muscle flap meets these criteria. Materials and Methods: Platysma muscle flap was advanced into the defect after excision of depressed scar. The procedure was done under local anesthetic in two patients. Result: The result was a ‘good scar’ with scar lying in the transversely oriented neck lines. Conclusions: Platysma muscle flap has a definitive role in revision surgery of depressed scars in neck as it provides an ideal tissue for lost tissue volume.
Sandhir, Rakesh K.; Jindal, Bharat R.; Sandhir, Shivanjali
This research seeks to develop non-invasive burn depth evaluation from non-contacting visible and near-infrared spectroscopic measurements. In previous years, we demonstrated that features of the optical reflection spectra of burn wounds can be correlated...
M. A. Afromowitz J. D. Callis
Recent evidence suggests that ligaments are subject to repetitive loads in vivo. Hence, the creep behaviour (increase in strain under constant or repetitive stress) of ligament scars is of significance, since healing ligaments may elongate permanently over time. A rabbit medial collateral ligament model was used to assess the creep behaviour of healing ligaments at stresses corresponding to 30% of the scar failure strength at 3 (n = 6), 6 (n = 6), and 14 (n = 5) weeks of healing. The stresses for the creep tests of scars (and contralateral controls) were 2.2, 4.1, and 7.1 MPa for the 3, 6, and 14-week healing intervals, respectively. Normal medial collateral ligaments from comparable rabbits were tested at two of the corresponding stresses: 4.1 (n = 7) and 7.1 (n = 6) MPa. Total creep strain-the cumulative increase in strain resulting from serial cyclic and static creep testing-was independent of the order of testing and was compared between scars and controls. Water contents after testing were also quantified. Water contents before testing were assessed for additional animals: six normal animals and three from each healing interval. At 3 weeks of healing, the total creep strain of medial collateral ligament scars was four times greater than that for contralateral controls tested at the same stress. Although there was improvement from 3 to 14 weeks, the total creep strain of scars remained more than two times greater than that of controls at 14 weeks. Scar water content decreased with healing from elevated initial values, possibly contributing to the marginally improved creep response. Comparisons of this deficiency in scar creep with previously published scar abnormalities in the same model suggest that collagen crosslink density, proteoglycan content, soft-tissue flaws, and the combined effect of collagen fibre changes may be mechanistic factors involved in scar creep. PMID:10815824
Thornton, G M; Leask, G P; Shrive, N G; Frank, C B
Introduction: The rate of attempted vaginal birth after previous cesarean delivery has decreased, while the success rate of such births increased. Advances in surgical techniques, the development of anesthesiology services, particularly endotracheal anesthesia, very quality postoperative care with cardiovascular, respiratory and biochemical resuscitation, significantly reduce maternal mortality and morbidity after cesarean section. Progress and development of neonatal services, and intensive care of newborns is enabled and a high survival of newborn infants. Complications after cesarean section were reduced, and the introduction of prophylaxis and therapy of powerful antibiotics, as well as materials for sewing drastically reduce all forms of puerperal infection. Goal: Goal was to establish a measurement value of the parameters that are evaluated by ultrasound. Material and methods: Each of the measured parameters was scored. The sum of points is shown in tables. Based on the sum of points was done an estimate of the scar on the uterus after previous caesarian section and make the decision whether to complete delivery naturally or repeat cesarean section. We conducted a prospective study of 108 pregnant women. Analyzed were: shape scar thickness (thickening), continuity, border scar out, echoing the structure of the lower uterine segment and scar volume Results: The study showed that scar thickness of 3.5 mm or more, the homogeneity of the scar, scar triangular shape, qualitatively richer perfusion, and scar volume verified by 3D technique up to10 cm are attributes of the quality of the scar. Conclusion: Based on the obtained results we conclude that ultrasound evaluation of the quality of the scar has practical application in the decision on the mode of delivery in women who had previously given birth by Caesarean section.
Basic, Ejub; Basic-Cetkovic, Vesna; Kozaric, Hadzo; Rama, Admir
The Burning Rate Emulator is a gas fuel investigation attempting to emulate the burning of solids to improve our understanding of materials''flammability over a wide range of conditions. The approach relies on the fact that all burning solids are first converted into a gas. By understanding the rate of gasification and other physical properties of a given solid material, the experiments will emulate the burning process by carefully controlling a gas flame
Linear scar formation in the scalp after suturing an incision has been considered unavoidable. It was not known why scars formed even if the hair bulb was left intact. The authors developed a subcutaneous tissue-shaving method for radical treatment of bromidrosis and studied the process of hair regeneration by using thick-tissue specimens. They suggest that stem cells (lower) are located
Yoshikata Inaba; Masumi Inaba
Two patients with burns following petrol sniffing are presented. They sustained an 8 per cent and a 70 per cent total body surface area burn. The majority of the burned areas of both patients were full thickness and were treated by early excision and autografting, and in one patient with cultured epidermal autografts also. Both patients came from disorganized families,
T. F. Janeži?
The successful treatment of major burns depends upon accurate and early fluid replacement in the first 36 h. A burns calculator has been designed, based upon the Muir and Barclay formula, which should facilitate the estimation of fluid requirements in burned patients and therefore improve their immediate management in accident and emergency departments. ImagesFIG. 2
Jenkinson, Lloyd R
To fully understand the carbon (C) cycle impacts of forest fires, both C emissions during the fire and post-disturbance fluxes need to be considered. The latter are dominated by soil respiration (Rs), which is still subject to large uncertainties. This research investigates Rs in a boreal jack pine fire scar chronosequence at Sharpsand Creek, Ontario, Canada. During two field campaigns in 2006 and 2007, Rs was measured in a chronosequence of fire scars aged between 0 and 59 years since the last fire. Mean Rs per fire scar was adjusted for soil temperature (Ts) and soil moisture (Ms) (denoted
Smith, D. R.; Kaduk, J. D.; Balzter, H.; Wooster, M. J.; Mottram, G. N.; Lynham, T. J.; Studens, J.; Curry, J.; Hartley, G.; Stocks, B. J.
Remote sensing using Landsat Thematic Mapper (TM) satellite imagery is increasingly used for mapping wildland fire burned area and burn severity, owing to its frequency of collection, relatively high resolution, and availability free of charge. However, rapid response of vegetation following fire and frequent cloud cover pose challenges to this approach in the southeastern US. We assessed these timing constraints by using a series of Landsat TM images to determine how rapidly the remotely sensed burn scar signature fades following prescribed burns in wet flatwoods and depression swamp community types in the Apalachicola National Forest, Florida, USA during 2006. We used both the Normalized Burn Ratio (NBR) of reflectance bands sensitive to vegetation and exposed soil cover, as well as the change in NBR from before to after fire (dNBR), to estimate burned area. We also determined the average and maximum amount of time following fire required to obtain a cloud-free image for burns in each month of the year, as well as the predicted effect of this time lag on percent accuracy of burn scar estimates. Using both NBR and dNBR, the detectable area decreased linearly 9% per month on average over the first four months following fire. Our findings suggest that the NBR and dNBR methods for monitoring burned area in common southeastern US vegetation community types are limited to an average of 78-90% accuracy among months of the year, with individual burns having values as low as 38%, if restricted to use of Landsat 5 TM imagery. However, the majority of burns can still be mapped at accuracies similar to those in other regions of the US, and access to additional sources of satellite imagery would improve overall accuracy. ?? 2011 by the authors.
Picotte, J. J.; Robertson, K.
The purpose of this study was to report the results of the surgical treatment of spastic knee flexion contracture using tenotomy and progressive correction by external fixator–distractor devices. The study design involved a prospective observational study of 16 knees in nine patients with spastic flexion contracture greater than 30°. Treatment was indicated for both ambulatory and nonambulatory patients; and, in the latter group when sitting or personal hygiene was compromised. The average age was 11.6 years (range 10–17). Five of the patients were male and four female. There was one case of hemiplegia (11.1%), two cases of paraplegia (22.2%), and six cases of quadriplegia (66.7%). Six patients retained some walking capacity, while three had none. In all cases, distal lengthening of the hamstrings was carried out. A monolateral fixator with a gradual correction device was applied for a period of 4.8 weeks. The average follow-up was 26.6 months. The preoperative straight-leg raise was 55°. The popliteal angle was 58° preoperatively (range 30–80°), 8.5° on removal of the fixator, and 20° at the end of the follow-up. Complications: There were no superficial or deep infections, and no fractures or distal sensory–motor alterations. There was one case of arthrodiatasis of the knee (6.3%) which was resolved when the fixator was removed, and 11 cases of pin-track infection (68.7%) which were resolved with local care and oral antibiotics. To conclude, spastic knee flexion contracture can be treated gradually with monolateral external fixator with distraction devices, and with distraction modules which prevent acute stretching of the posterior neurovascular structures of the knee.
Valero, Jose Valiente; Fernandez, Pedro Domenech; Vicente-Franqueira, Javier Roca
Keloids are benign skin tumors and are the effect of a dysregulated wound-healing process in genetically predisposed patients. They are characterized by formation of excess scar tissue beyond the boundaries of the wound. Keloids are often confused with hypertrophic scars because of an apparent lack of morphologic differences. The molecular distinction between scars and keloid is still controversial and, until today, there is no appropriate treatment yet for keloid disease. In this study, we have found, for the first time, p53 mutations in both hypertrophic scar and keloids fibroblasts from cultured cells to various extents. Since p53 plays a central role in the DNA damage response by inducing cell cycle arrest and/or apoptotic cell death, we also set up time course experiments making cell cultures at different times to investigate the phenomenon of apoptosis and its involvement in the process of pathological scarring in both hypertrophic scars and keloids. The extent of apoptosis in this study was investigated by DNA fragmentation and MTT assays, propidium iodide staining, p53 expression, and subcellular distribution. Moreover, the correlation of apoptosis and ROS levels in keloid and hypertrophic scars fibroblasts was assessed. Understanding the molecular mechanisms that determine the regulation of apoptosis during wound healing might allow us to therapeutically modulate these pathways so that apoptotic cell death is reactivated in dysregulated and hypertrophic cells. PMID:19224335
De Felice, Bruna; Garbi, Corrado; Santoriello, Margherita; Santillo, Alessandra; Wilson, Robert R
Estimation of chronological age from skeletal material is dependent upon estimation of maturational stage observed. Following completion of epiphyseal fusion, a transverse radio-opaque line, termed "epiphyseal scar", may be observed in the region of the former growth plate. According to the literature, this line is likely to become obliterated shortly after completion of epiphyseal fusion. Consequently, presence of an epiphyseal scar has been interpreted as an indication of recent epiphyseal fusion; however, this has not been validated by quantitative research. A study was undertaken to determine persistence of the epiphyseal scars in a cross-sectional population of adults between 20 and 50 years of age. This study examined 1,216 radiographs of proximal and distal tibiae from both sexes and sides of the body. This study suggested that 98.05 % of females and 97.74 % of males retained some remnant of the epiphyseal scar at the proximal tibia whilst 92.72 % of females and 92.95 % of males retained some remnant of the epiphyseal scar at the distal tibia. General linear model (GLM) analysis determined that chronological age accounted for 2.7 % and 7.6 % of variation in persistence of the epiphyseal scar at the proximal and distal tibiae, respectively. This study suggests that obliteration of the epiphyseal scar is not as dependent on chronological age as previously thought. It is, therefore, recommended that this feature not be used as an indicator of chronological age during forensic age assessment. PMID:23471589
Davies, Catriona; Hackman, Lucina; Black, Sue
Pediatric burns comprise a major mechanism of injury, affecting millions of children worldwide, with causes including scald injury, fire injury, and child abuse. Burn injuries tend to be classified based on the total body surface area involved and the depth of injury. Large burn injuries have multisystemic manifestations, including injuries to all major organ systems, requiring close supportive and therapeutic measures. Management of burn injuries requires intensive medical therapy for multi-organ dysfunction/failure, and aggressive surgical therapy to prevent sepsis and secondary complications. In addition, pain management throughout this period is vital. Specialized burn centers, which care for these patients with multidisciplinary teams, may be the best places to treat children with major thermal injuries. This review highlights the major components of burn care, stressing the pathophysiologic consequences of burn injury, circulatory and respiratory care, surgical management, and pain management of these often critically ill patients.
Krishnamoorthy, Vijay; Ramaiah, Ramesh; Bhananker, Sanjay M
Collodion baby is a rare congenital disorder whereby affected infants are born encased in a thick, taut, shiny, translucent membrane. The majority of babies with collodion membrane have associated disorders, most commonly nonbullous congenital ichthyosiform erythroderma and lamellar ichthyosis. The authors report a case of collodion baby with rare complication of acral contracture, ischemia and nail dystrophy. Topical treatment with tazarotene 0.1% gel resulted in rapid improvement. The patient developed normal nail plates and full motor function in both hands and feet following treatment. To the authors' knowledge, this is the first report demonstrating the benefit of topical tazarotene for management of this rare condition in a neonate. PMID:20645539
Liu, Rosemarie H; Becker, Beth; Gunkel, Juliet; Teng, Joyce
The author examined the carpalia of 40 male alcoholics suffering from Stage I of Dupuytren's contracture. In four subjects he observed a cortical hyperostosis of the right pisiform bone on the tangential films. The hyperostosis can be ascribed to the ethanol-induced hyperlipoproteinemia type II/B. The lipoids leaving the vascular paths infiltrate the connective tissue capsule of the pisiform bone and stimulate the formation of osteoblasts at the border between bone and soft tissue. The ossification must be regarded as enteropathic hyperostosis. PMID:3832681
Introduction: Managing burn injury-associated pain and wounds is a major unresolved clinical problem. Opioids, nonsteroidal antiinflammatory drugs (NSAIDs), antidepressants and anticonvulsants remain the most common forms of analgesic therapy to treat burn patients. However, prolonged treatment with these drugs leads to dose escalation and serious side effects. Additionally, severe burn wounds cause scarring and are susceptible to infection. Recent encouraging findings demonstrate that curcumin, a major bioactive component found in turmeric, is a natural pharmacotherapeutic for controlling both severe burn pain and for improved wound healing. Areas covered: This article covers current pr-clinical and clinical studies on the analgesic and wound healing effects. Particular emphasis has been placed on studies aimed at developing improved curcumin delivery vehicles that increase its bioavailability. Based on the available evidence, a hypothesis is proposed that the dual beneficial effects of curcumin, analgesia and enhanced wound healing are mediated through common anti-inflammatory mechanisms. Expert opinion: Emerging studies have demonstrated that curcumin is a promising investigational drug to treat both pain and wounds. The adequate control of severe burn pain, particularly over the long courses required for healing, as well improvements in burn wound healing are unmet clinical needs. PMID:23902423
Cheppudira, Bopaiah; Fowler, Marcie; McGhee, Laura; Greer, Angie; Mares, Alberto; Petz, Lawrence; Devore, David; Loyd, Dayna R; Clifford, John L
This study presents a multi-modality image registration method that evaluates left atrial scarring after radiofrequency (RF) ablation for pulmonary vein (PV) isolation. Our group has recently developed a delayed enhancement magnetic resonance imaging (DE-MRI) method with the potential to visualize and monitor non-invasively post-ablation scarring in the left atrium and the PV ostia. We wished to compare the 3D configuration of scarring in the DE-MRI image and the ablation points recorded by electroanatomical mapping (EAM) system, hypothesizing that scarring detected by DE-MRI overlaps with ablation points recorded by the EAM system used in the procedure. Methods and Results: Three data sets, DE-MRI images and pulmonary vein MR angiography (PV-MRA) images, and EAM data (CARTO-XP, Biosense-Webster, Inc., Diamond Bar, CA) from a patient who underwent PV ablation, were used for the multi-modal image registration. Contrast-enhanced MR imaging was performed 38 days after the ablation procedure. PV-MRA and DE-MRI were fused by intensity-based rigid registration. Scar tissue was extracted from the DE-MRI images using multiple threshold values. EAM data was further fused with segmented PV-MRA by the iterative closest point algorithm (ICP). After registration, the distance from PV-MRA to the scar was 2.6 +/- 2.1 mm, and from ablation points to the surface of the scar was 2.5 +/- 2.3 mm. The fused image demonstrates the 3D relationship between the PV ostia, the scar and the EAM recording of ablation points. Conclusion: Multimodal data fusion indicated that the scar tissue lesion after PV isolation showed good overlap with the ablation points.
Ishihara, Yuri; Nazafat, Reza; Wylie, John V.; Linguraru, Marius G.; Josephson, Mark E.; Howe, Robert D.; Manning, Warren J.; Peters, Dana C.
Total obstetric brachial plexus palsy in children with internal rotation contracture of the shoulder, flexion contracture of the elbow, and poor hand function: improving the cosmetic appearance of the limb with rotation osteotomy of the humerus.
Rotation osteotomy of the humerus has been described by several authors to treat the internal rotation contracture of the shoulder in Erb palsy. The main aim of the osteotomy in Erb patients is to bring the functioning hand to the face which greatly improves function. The author has performed the rotation humeral osteotomy in children with total obstetric brachial plexus palsy aiming for the improvement of the cosmetic appearance of the limb rather than improvement function. This article specifically reports on this group of patients.Over the last 15 years, the author has performed rotation humeral osteotomy in 13 children (mean age 6 years; range, 4.5-9 years) with total obstetric brachial plexus palsy aiming for improvement of the cosmetic appearance of the limb rather than improvement of function. All children had a triad of severe internal rotation contracture of the shoulder, severe flexion contracture of the elbow, and poor hand function.After a mean follow-up of 2 years following the humeral osteotomy, all patients/parents were satisfied with the result and a panel of plastic surgeons confirmed the significant improvement in aesthetics. Reasons for this improvement following the osteotomy were as follows: the child no longer needed to stand with shoulder slightly abducted, the antecubital fossa became visible in the standing position, and the forearm no longer appeared excessively pronated. Of more importance, was the improvement in elbow flexion contracture which had major contribution in improving limb appearance and the perception of length discrepancy between the affected and the contralateral normal limb.The humeral osteotomy improves the cosmetic appearance of children with total palsy and the triad of severe internal rotation contracture of the shoulder, severe flexion contracture of the elbow and poor hand function. PMID:20548233
Al-Qattan, Mohammad M
Extracellular signal-regulated kinase (ERK)-2 is presumed to play an important role in the development of post-traumatic joint contractures. Using a rat injury model, we investigated whether treatment with ERK2 small interfering RNA (siRNA) could reduce the extent of joint capsule fibrosis after an induced injury. Rats were separated into three groups (n = 32 each): non-operated control group, operated contracture group and contracture-treatment group. Stable post-traumatic joint contracture was created through surgical intra-articular joint injury followed by eight weeks of immobilization. In the contracture-treatment group, the rats were treated with lentivirus (LV)-mediated ERK2 siRNA at days 3 and 7 post-surgery. The posterior joint capsule was assessed by western blotting, immunohistochemistry and biochemical analysis for changes in ERK2, phosphorylated (p)-ERK2, myofibroblast, total collagen and relative collagen Type III expression level. Biomechanical testing was used to assess the development of flexion contractures. Statistical analysis was performed using an analysis of variance. In the operated contracture group, rats that developed flexion contractures also showed elevated phosphorylated p-ERK2 expression. In the contracture-treatment group, ERK2 siRNA significantly reduced p-ERK2 expression levels, as well as the severity of flexion contracture development (p < 0.01). Myofibroblast numbers and measurements of total collagen content were also significantly reduced following ERK2 siRNA (p < 0.01). Relative collagen type III expression as a proportion of total of Types I and III collagen, however, was significantly increased in response to ERK2 siRNA (p < 0.01). Our findings demonstrate a role for ERK2 in the induction of joint capsule fibrosis after injury. Furthermore, we show that development of flexion contractures and the resultant increase of joint capsule fibrosis can be reduced by LV-mediated ERK2 siRNA treatment. PMID:24141184
Li, Fengfeng; Liu, Shen; Fan, Cunyi
Atrophic acne scarring is an unfortunate, permanent complication of acne vulgaris, which may be associated with significant psychological distress. General dermatologists are frequently presented with the challenge of evaluating and providing treatment recommendations to patients with acne scars. This article reviews a practical, step-by-step approach to evaluating the patient with atrophic acne scars. An algorithm for providing treatment options is presented, along with pitfalls to avoid. A few select procedures that may be incorporated into a general dermatology practice are reviewed in greater detail, including filler injections, skin needling, and the punch excision.
Pregnancy implantation within previous caesarean scar is one of the rarest locations for an ectopic pregnancy. Incidence of caesarean section is increasing worldwide and with more liberal use of transvaginal sonography, more cases of caesarean scar pregnancy are being diagnosed in early pregnancy thus allowing preservation of uterus and fertility. However, a delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, and significant maternal morbidity. We are reporting a rare case of first trimester caesarean scar pregnancy with viable fetus in the process of rupture, where uterine repair could be done, thus preserving the future fertility.
Singh, Kamal; Soni, Anjali; Rana, Shelly
Background: The performance and results of corneal tattooing are described in a case series of 11 patients suffering from a disfiguring corneal scar using a technique similar to conventional dermatography. Methods: Drawing ink in different shades was applied into the anterior corneal stroma by punctures performed with a conventional spatula needle. Results: Up to 4 years after surgery all patients still had satisfactory staining of the formerly cosmetically disfiguring corneal scar. Conclusion: Tattooing of unsightly corneal scars proved to be an efficient and easy to perform technique, yielding acceptable results during follow up.
Pitz, S; Jahn, R; Frisch, L; Duis, A; Pfeiffer, N
This case demonstrates the use of QRS scoring to quantify myocardial scar in a patient with cardiac sarcoidosis and left bundle branch block who progressively received an implantable defibrillator, cardiac resynchronization therapy (CRT), left ventricular assist device and cardiac transplantation. QRS scoring has been shown to correlate with magnetic resonance imaging measurements of scar, identify arrhythmogenic substrate and predict response to CRT, but had not previously been compared to pathology-documented scar in nonischemic cardiomyopathies. Further study is warranted to assess the ability of QRS scoring to guide therapy for individual patients. PMID:21496175
Strauss, David G; Selvester, Ronald H; Dibernardo, Louis R
Burning mouth syndrome is a complex disorder of unclear etiology that is most prevalent in perimenopausal women. It is often accompanied by dysguesia and subjective xerostomia. Recent evidence implicates both central and peripheral neuropathies, possibly representing a phantom pain syndrome in some patients. Ensuring that the patient's oral burning is not secondary to some other local or systemic factor is central to appropriate management. Current standard therapies include clonazepam, paroxetine, and cognitive behavioral therapy, and several promising new alternatives are described. PMID:21093630
Minor, Jacob S; Epstein, Joel B
Due to progress in burn treatment, more patients even with severe burn injuries survive. Despite this positive development, however, there are still negative somatic and mental consequences. These include the life-long care of scars and pain. In addition, posttraumatic-stress disorder and depression are common consequences. Also distress due to disfigurement and body image problems have to be considered, since this is likely to result in social withdrawal, low self-esteem, and reduction of quality of life. Overall, the impact of mental strain on burn victims is quite high. Therefore, psychotherapeutic treatment approaches should be integrated into the care of patients with burns. This might be helpful for both coping and compliance with long-term treatment. This paper provides a review of the mental co-morbidity of burn victims and of psychotherapeutic treatment approaches focusing on changes in body image and the respective social consequences. PMID:23709185
Jasper, Stefanie; Oliver Rennekampff, Hans-; de Zwaan, Martina
Tropical deforestation and forest degradation contribute to about 20% of the global greenhouse gas emissions and Indonesia is a leading emitter. Forests are certainly critical; but the peat soils beneath can store 30 times more carbon than the trees above. Indonesia has the fourth-largest area of peatland in the world, ranging from 30 to 45 million ha, which is approximately
U. Ballhorn; F. Siegert
The diagnosis of adrenal insufficiency is discussed in case of low blood pressure and digestive symptoms. Rare inaugural abdomino-crural muscle contracture can be a misleading symptom. Here we report two new cases. A 50-year-old woman presenting a leaning forward walking attitude and negligence for the past 2 months was referred to the neurologic unit. Abdomino-crural contracture, clinical hypogonadism, and hyponatremia directed towards a panhypopituitarism, which was confirmed by subsequent investigations. Pituitary MRI found an empty sella turcica. The outcome was dramatic after hormone replacement therapy, with drawing up of the trunk and re-establishment of walking after a few days. The second case is a 58-year-old man, hospitalized with altered general condition, with a weight loss of 22 kg, and anorexia in the aftermath of a comminuted fracture of the right lower limb, complicated by pseudoarthrosis. There was amyotrophy on the extremities with intense cruralgia. The patient had an antalgic attitude in the flexion affecting his rehabilitation. During 1 year, the symptoms were mimicking psychiatric disorders, malabsorption, or cancer before the final diagnosis of central hypocorticism with normal MRI was established. The evolution was remarkable after a few days of therapy with hydrocortisone, where the myalgia disappeared, the patient quickly gained weight, and the disappearance of the retractions allowed rehabilitation. These two observations emphasize the delayed diagnosis of adrenal insufficiency in the case of abdomino-crural-related symptoms and the presence of misleading neurological symptoms. The mechanisms of this syndrome remain unknown. PMID:20157722
Harbuz, Viorica; Bihan, Hélène; Salama, Jeffrey; Reach, Gérard; Cohen, Régis
There is a trend of increasing childhood aggression in America, which has been tied to bullying. Although there is growing research concerning bullying in the general pediatric population, there are limited data on bullying and its effects on children with disfigurements and physical limitations. This study was conducted to assess burned children's experience with bullying. A pretest was administered regarding experience with bullying and teasing. A curriculum regarding bullying, which incorporated the Harry Potter and the Sorcerer's Stone movie, was presented. After reviewing bullying depicted in the film and participating in a class regarding bullying, children were invited to complete a survey regarding their experience with bullying. A total of 61% of these children reported being bullied at school; 25% reported experiencing headaches or stomachaches due to bullying, and 12% reported staying home from school. Nearly 25% reported bullying as a big problem. Of those with visible scars (55%), a full 68% reported bullying as a problem, versus 54% with hidden scars (P < .05). However, those with visible scars were no more likely to tell an adult (54%) than those without (56%). Children were much more willing to disclose personal bullying experiences after participating in the class (57%) than before (45%) (P < .01). This study revealed that bullying impacts many burn-injured children and has negative effects on their physical and mental well-being. Many children (with visible or hidden scars) did not seek adult intervention for the problem. Participation in a bullying course appears to give children a forum that increases their willingness to disclose personal bullying experiences and can provide them with prevention information and a safe place to seek help. PMID:17438488
Rimmer, Ruth B; Foster, Kevin N; Bay, Curtis R; Floros, Jim; Rutter, Cindy; Bosch, Jim; Wadsworth, Michelle M; Caruso, Daniel M
Emery-Dreifuss muscular dystrophy (EDMD) is a hereditary neuromuscular disorder characterized by slowly progressive muscle weakness, early contractures, and dilated cardiomyopathy. We reported an uneventful general anaesthesia using total intravenous anaesthesia (TIVA) for cardiac transplantation in a 19-year-old woman suffering from EDMD. In vitro contracture test results of two pectoralis major muscle bundles of the patient suggest that exposition to triggering agents does not induce a pathological sarcoplasmic calcium release in the lamin A/C phenotype. However, due to the lack of evidence in the literature, we would recommend TIVA for patients with EDMD if general anaesthesia is required.
Schuster, Frank; Wessig, Carsten; Schimmer, Christoph; Johannsen, Stephan; Lazarus, Marc; Aleksic, Ivan; Leyh, Rainer; Roewer, Norbert
Bogomolny's formula for energy-smoothed scars is applied to a nonspecific, nonscalable Hamiltonian, a two-dimensional anharmonic oscillator. The semiclassical theory reproduces well the exact quantal results over a large spatial and energy range.
Provost, D.; Baranger, M. (Center for Theoretical Physics, Laboratory for Nuclear Science, Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139 (United States))
... class="button-learn-more"> From crow's feet to spider veins... You'll look and feel your best ... Fat Excessive Sweating Hair Loss Scars Skin Growths Spider Veins Unwanted Hair Unwanted Tattoos Varicose Veins Wrinkled ...
This study presents a multi-modality image registration method that evaluates left atrial scarring after radiofrequency (RF) ablation for pulmonary vein (PV) isolation. Our group has recently developed a delayed enhancement magnetic resonance imaging (DE-MRI) method with the potential to visualize and monitor non-invasively post-ablation scarring in the left atrium and the PV ostia. We wished to compare the 3D configuration
Yuri Ishihara; Reza Nazafat; John V. Wylie; Marius G. Linguraru; Mark E. Josephson; Robert D. Howe; Warren J. Manning; Dana C. Peters
To avoid hypertrophic scars in burn wounds, the simultaneous application of basic fibroblast growth factor (bFGF) with regular surgical debridement and skin grafting was investigated for skin hardness by clinical examination and instrumental measurement. As little is known about the role of bFGF in wounds, burn wound scars were tested for hardness. Burn scars in various anatomical locations at least 1 year after final wound healing clinically demonstrated a significantly lower hard score in bFGF-treated wounds than in non-bFGF wounds (0.95+/-0.51 versus 2.3+/-0.66, respectively, p<0.01). In addition, a durometer, which is widely used in industry to measure materials similar to skin, such as rubber and thread-balls, demonstrated a significantly lower reading in bFGF-treated wounds than in non-bFGF wounds (7.9+/-3.64 versus 15.5+/-4.39, bFGF versus non-bFGF, respectively, p<0.01). The results demonstrated that burn wounds treated with clinically approved bFGF might contribute to a better cutaneous wound quality, at least in terms of hardness. PMID:16199295
Akita, Sadanori; Akino, Kozo; Imaizumi, Toshifumi; Hirano, Akiyoshi
Fire history reconstructions are typically based on tree ages and tree-ring fire scars or on charcoal in sedimentary records from lakes or bogs, but rarely on both. In this study of fire history in western Patagonia (47-48° S) in southern South America (SSA) we compared three sedimentary charcoal records collected in bogs with tree-ring fire-scar data collected at 13 nearby sample sites. We examined the temporal and spatial correspondence between the two fire proxies and also compared them to published charcoal records from distant sites in SSA, and with published proxy reconstructions of regional climate variability and large-scale climate modes. Two of our three charcoal records record fire activity for the last 4 ka yr and one for the last 11 ka yr. For the last ca. 400 yr, charcoal accumulation peaks tend to coincide with high fire activity in the tree-ring fire scar records, but the charcoal records failed to detect some of the fire activity recorded by tree rings. Potentially, this discrepancy reflects low-severity fires that burn in herbaceous and other fine fuels without depositing charcoal in the sedimentary record. Periods of high fire activity tended to be synchronous across sample areas, across proxy types, and with proxy records of regional climatic variability as well as major climate drivers. Fire activity throughout the Holocene in western Patagonia has responded to regional climate variation affecting a broad region of southern South America that is teleconnected to both tropical- and high-latitude climate drivers-El Niño-Southern Oscillation and the Southern Annular Mode. An early Holocene peak in fire activity pre-dates any known human presence in our study area, and consequently implicates lightning as the ignition source. In contrast, the increased fire activity during the 20th century, which was concomitantly recorded by charcoal from all the sampled bogs and at all fire-scar sample sites, is attributed to human-set fires and is outside the range of variability characteristic of these ecosystems over many centuries and probably millennia.
Holz, A.; Haberle, S.; Veblen, T. T.; de Pol-Holz, R.; Southon, J.
This study aims to investigate the effect of Endostar injection on the rabbit ear hypertrophic scar formation and expand the use of Endostar. The rabbit ear hypertrophic scar models were established 4 weeks postoperation and were treated with Endostar injection; the control group was injected with saline, once a week, 3 times totally. At the seventh week, the scar tissue was harvested and processed with hematoxylin and eosin (HE) staining and CD34 immunohistochemistry and cell apoptosis assay. In addition, the endothelial cell was cultured and seeded on Martrigel with different concentrations of Endostar to observe the vessel tube formation. The results showed that the volume of the hypertrophic scar with Endostar injection was greatly reduced compared with what was seen in the control group; meanwhile, HE staining showed that the cell number decreased and collagen density became looser. In addition, the CD34 staining indicated that microvessel formation in the study group also decreased and cell apoptosis increased. In vitro, the addition of Endostar could reduce vessel tube formation in a dose-dependent manner. In conclusion, the Endostar is effective for hypertrophic scar inhibition and could be a potential tool to treat scars. PMID:23089964
ZhiYong, Wang; Fei, Song; LianJu, Xu; Yingkai, Liu; Chun, Qing; Shuliang, Lu; XiQiao, Wang
Scar formation is a potentially detrimental process of tissue restoration in adults, affecting organ form and function. During fetal development, cutaneous wounds heal without inflammation or scarring at early stages of development; however, they begin to heal with significant inflammation and scarring as the skin becomes more mature. One possible cell type that could regulate the change from scarless to fibrotic healing is the mast cell. We show here that dermal mast cells in scarless wounds generated at embryonic day 15 (E15) are fewer in number, less mature, and do not degranulate in response to wounding as effectively as mast cells of fibrotic wounds made at embryonic day 18 (E18). Differences were also observed between cultured mast cells from E15 and E18 skin, with regard to degranulation and preformed cytokine levels. Injection of mast cell lysates into E15 wounds disrupted scarless healing, suggesting that mast cells interfere with scarless repair. Finally, wounds produced at E18, which normally heal with a scar, healed with significantly smaller scars in mast cell-deficient Kit(W/W-v) mice compared with Kit(+/+) littermates. Together, these data suggest that mast cells enhance scar formation, and that these cells may mediate the transition from scarless to fibrotic healing during fetal development. PMID:21993557
Wulff, Brian C; Parent, Allison E; Meleski, Melissa A; DiPietro, Luisa A; Schrementi, Megan E; Wilgus, Traci A
Scar formation is a potentially detrimental process of tissue restoration in adults, affecting organ form and function. During fetal development, cutaneous wounds heal without inflammation or scarring at early stages of development, but begin to heal with significant inflammation and scarring as the skin becomes more mature. One possible cell type that could regulate the change from scarless to fibrotic healing is the mast cell. We show here that dermal mast cells in scarless wounds generated at embryonic day 15 (E15) are fewer in number, less mature and do not degranulate in response to wounding as effectively as mast cells of fibrotic wounds made at embryonic day 18 (E18). Differences were also observed between cultured mast cells from E15 and E18 skin with regard to degranulation and preformed cytokine levels. Injection of mast cell lysates into E15 wounds disrupted scarless healing, suggesting that mast cells interfere with scarless repair. Finally, wounds produced at E18, which normally heal with a scar, healed with significantly smaller scars in mast cell-deficient KitW/W-v mice compared to Kit+/+ littermates. Together, these data suggest that mast cells enhance scar formation, and that these cells may mediate the transition from scarless to fibrotic healing during fetal development.
Wulff, Brian C.; Parent, Allison E.; Meleski, Melissa A.; DiPietro, Luisa A.; Schrementi, Megan E.; Wilgus, Traci A.
Achievement of symmetry remains one of the goals of cosmetic procedures. Interestingly, scar asymmetry after abdominoplasty has been rarely considered a complication. However, this can have a significant impact on patient and surgeon satisfaction. This study identifies silent seromas as a potential cause of scar asymmetry.Among abdominoplasty procedures in a university hospital institution over a 30 months' period (October 1, 2007 to April 1, 2010), we retrospectively identified 6 patients who developed abdominal scar asymmetry only 3 months postoperatively and without any early warning complications (hematoma, seroma, or infection). Clinical examination was completed by abdominal diagnostic ultrasonography. Seroma capsulectomy under local anesthesia was performed in all cases.In all patients clinically presenting late abdominal scar asymmetry, ultrasonography confirmed the presence of an encapsulated chronic seroma. Surgical capsulectomy under local anesthesia resulted in reestablishment of former symmetry and high patient satisfaction. No complications such as wound infection, dehiscence, hematoma, or recurrence of seroma were detected after revision surgery.In our experience, fibrous capsule due to chronic seromas resulted in abdominal scar deviation and asymmetry. Surgical capsulectomy followed by wearing of compressive garments resulted to be an effective treatment with pleasant aesthetic outcome and no seroma recurrence. Silent seromas should be considered as a possible etiologic factor of scar asymmetries appearing during late follow-up after abdominoplasty. PMID:23143814
di Summa, Pietro Giovanni; Wettstein, Reto; Erba, Paolo; Raffoul, Wassim; Kalbermatten, Daniel Felix
Urinary tract infection (UTI) is a common bacterial illness in children. Acute pyelonephritis in children may lead to renal scarring with the risk of later hypertension, preeclampsia during pregnancy, proteinuria, and renal insufficiency. Until now, vesicoureteral reflux (VUR) has been considered the most important risk factor for post-UTI renal scar formation in children. VUR predisposes children with UTI to pyelonephritis, and both are associated with renal scarring. However, reflux nephropathy is not always acquired; rather, it reflects reflux-associated congenital dysplastic kidneys. The viewpoint that chronic kidney disease results from renal maldevelopment-associated VUR has led to questioning the utility of any regimen directed at identifying or treating VUR. Despite the recognition that underlying renal anomalies may be the cause of renal scarring that was previously attributed to infection, the prevention of renal scarring remains the goal of all therapies for childhood UTI. Therefore, children at high risk of renal scar formation after UTI should be treated and investigated until a large clinical study and basic research give us more information.
An 810-nm diode laser system was developed to accelerate and improve the healing process in surgical scars. Using thermal post-conditioning, the laser system provides a localised moderate heating whose maximum temperature is controlled to prevent tissue damage and stimulate the heat shock proteins (HSP) synthesis. The 810-nm wavelength allows a deep penetration of the light into the dermis, without damaging the epidermis. The time along which surgical incision is treated (continuous wave) must therefore be selected carefully with respect to the temperature precision achieved within the heated volume. A top-hat profile is preferred to a Gaussian profile in order to ensure the skin surface temperature is homogenised, as is the temperature of the heated volume. The spot shape will depend on the medical indication. The treatment should be made safe and controlled by means of a safety strip containing an RFID chip which will transmit the various operating settings to the laser device. A clinical trial aims at evaluating the 810 nm-diode laser in surgical incisions, with only one laser treatment immediately after skin closure, of patients with Fitzpatrick skin types I to IV. Surgical incisions were divided into two fields, with only portions randomly selected receiving laser treatment. At the final scar analysis (12 months) of the pilot study, the treated portion scored significantly better for both surgeon (P = 0.046) and patients (P = 0.025). Further studies may be warranted to better understand the cellular mechanisms leading to Laser-Assisted Skin Healing (LASH).
Gossé, Alban; Iarmarcovai, Gwen; Capon, Alexandre; Cornil, Alain; Mordon, Serge
The etiology and treatment of hypertrophic scar remain puzzles even after decades of research. A significant reason is the lack of an accepted animal model of the process. The female, red Duroc pig model was described long ago. Since the skin of the pig is similar to that of humans, we are attempting to validate this model and found it to be encouraging. In this project we quantified myofibroblasts, mast cells and collagen nodules in the thick scar of the Duroc pig and compared these to the values for human hypertrophic scar. We found the results to be quite similar and so further validated the model. In addition, we observed that soon after wounding an inflammatory cell layer forms. The thickness of the inflammatory layer approaches the thickness of the skin removed as if the remaining dermis “knows” how much dermis is gone. In deep wounds this inflammatory layer thickens and this thickness is predictive of the thickness of the ultimate scar.
Harunari, Nobuyuki; Zhu, Kathy Q.; Armendariz, Rebecca T.; Deubner, Heike; Muangman, Pornprom; Carrougher, Gretchen J.; Isik, F. Frank; Gibran, Nicole S.; Engrav, Loren H.
In this study, we evaluated the effects of silicone-based gel on the healing of hypertrophic scars in the rabbit ear model. After 4-week application of silicone-based gel containing allantoin, dexpanthenol and heparin (Noscarna™) to scars in a rabbit ear model of hypertrophic scarring, significant improvements in hypertrophic scar healing and a great loss of skin pigment were observed compared to the non-treated control, base or silicone control-treated scars. Furthermore, histological analysis of Noscarna™-treated scars revealed a significant reduction in scar elevation index (SEI), anterior skin and epithelial thicknesses, inflammatory cells, vessels, collagen disorganization and fibroblasts compared to all control hypertrophic scars. Furthermore, Noscarna™ showed more favorable effects on hypertrophic scars than a commercial product, Contractubex®. Therefore, these results clearly demonstrated that the newly developed silicone-based gel, Noscarna™, could be a promising formulation as an effective therapeutic agent for hypertrophic scars. PMID:23212642
Lee, Dong Won; Ku, Sae Kwang; Cho, Hyuk Jun; Kim, Jeong Hwan; Hiep, Tran Tuan; Han, Sang Duk; Kim, Bo Gyun; Kang, Min Kyung; Do, Eui Seon; Jun, Joon Ho; Jang, Sun Woo; Son, Mi-Won; Sohn, Young Taek; Choi, Han-Gon; Yong, Chul Soon; Kim, Jong Oh
Burn injury is a ubiquitous threat in the military environment. The risks during combat are well recognised, but the handling of fuel, oil, munitions and other hot or flammable materials during peacetime deployment and training also imposes an inherent risk of accidental burn injury. Over the last hundred years, the burn threat in combat has ranged from nuclear weapons to small shoulder-launched missiles. Materials such as napalm and white phosphorus plainly present a risk of burn, but the threat extends to encompass personnel in vehicles attacked by anti-armour weapons, large missiles, fuel-air explosives and detonations/conflagrations on weapons platforms such as ships. Large numbers of burn casualties were caused at Pearl Harbor, in Hiroshima and Nagasaki, Vietnam, during the Arab/Israeli Wars and in the Falkland Islands conflict. The threat from burns is unlikely to diminish, indeed new developments in weapons seek to exploit the vulnerability of the serviceman and servicewoman to burns. Clothing can be a barrier to some types of burn--both inherently in the properties of the material, but also by trapping air between clothing layers. Conversely, ignition of the clothing may exacerbate a burn. There is hearsay that burnt clothing products within a wound may complicate the clinical management, or that materials that melt (thermoplastic materials) should not be worn if there is a burn threat. This paper explores the incidence of burn injury, the mechanisms of heat transfer to bare skin and skin covered by materials, and the published evidence for the complication of wound management by materials. Even light-weight combat clothing can offer significant protection to skin from short duration flash burns; the most vulnerable areas are the parts of the body not covered--face and hands. Multilayered combat clothing can offer significant protection for short periods from engulfment by flames; lightweight tropical wear with few layers offers little protection. Under high heat loads in the laboratory, combat clothing can ignite, but there is little evidence that clothing ignition is a common occurrence in military burn casualties. Thermoplastic materials have many benefits in civil and military clothing. There is little objective evidence that they exacerbate burns, or complicate burn management. Their use in military clothing must be based on objective evidence, not hearsay. PMID:11307683
McLean, A D
Summary Full-thickness skingraft is a valid option to release burn scar contractures with the main purpose of correcting the induced limitation in function and improve the disfiguring appearance of the scar. The main pitfall remains the limited availability of these grafts, especially when large sheets are needed. We present an application of a previously described technique known as reverse tissue expansion, which permits the harvesting of a large sheet of full thickness skin graft when needed. This method was adopted to release a burn scar contracture in a 32-yr-old man who sustained a 65% TBSA burn secondary to a gasoline tank explosion at the age of 7 yr followed by multiple reconstructive procedures. The patient presented with a disfiguring anterior neck contracture coupled to limited range of motion. Improvement of neck extension was contemplated using full-thickness skin graft harvested following reverse tissue expansion achieved by deflation liposuction of the donor site.
Ibrahim, A.E.; Debbas, C.C.; Dibo, S.A.; Atiyeh, B.S.; Abu-Sittah, G.S.; Isik, S.
Limb girdle muscular dystrophy 2A is a common variant secondary to mutations in the calpain 3 gene. A proportion of patients has early and severe contractures, which can cause diagnostic difficulties with other conditions. We report clinical and muscle magnetic resonance imaging findings in seven limb girdle muscular dystrophy 2A patients (four sporadic and three familial) who had prominent and
Eugenio Mercuri; Kate Bushby; Enzo Ricci; Daniel Birchall; Marika Pane; Maria Kinali; Joanna Allsop; Vincenzo Nigro; Amets Sáenz; Annachiara Nascimbeni; Luigi Fulizio; Corrado Angelini; Francesco Muntoni
Breast capsular contracture formation following silicone implant augmentation/reconstruction is a common complication that remains poorly understood. The aim of this study was to identify potential biomarkers implicated in breast capsular contracture formation by using, for the first time, whole genome arrays. Biopsy samples were taken from 18 patients (23 breast capsules) with Baker Grade I-II (Control) and Baker Grade III-IV (Contracted). Whole genome microarrays were performed and six significantly dysregulated genes were selected for further validation with quantitative reverse transcriptase polymerase chain reaction and immunohistochemistry. Hematoxylin and eosin was also carried out to compare the histological characteristics of control and contracted samples. Microarray results showed that aggrecan, tissue inhibitor of metalloproteinase 4 (TIMP4), and tumor necrosis factor superfamily (ligand) member 11 were significantly down-regulated in contracted capsules; while matrix metallopeptidase 12, serum amyloid A 1, and interleukin 8 (IL8) were significantly up-regulated. The dysregulation of aggrecan, tumor necrosis factor superfamily (ligand) member 11, TIMP4, and IL8 was validated by quantitative reverse transcriptase polymerase chain reaction (p?0.05). Immunohistochemistry confirmed an increased protein expression for IL8 and matrix metallopeptidase 12 in contracted capsules (p?0.05), and decreased protein expression of TIMP4 (p?0.05). This study has shown, for the first time, a number of unique biomarkers of significance in capsular contracture formation. IL8 and TIMP4 may serve as potential key diagnostic, therapeutic, and prognostic biomarkers in capsular contracture formation. PMID:23941504
Kyle, Daniel J T; Harvey, Alison G; Shih, Barbara; Tan, Kian T; Chaudhry, Iskander H; Bayat, Ardeshir
S-2-(3-Aminopropylamino)ethylphosphorothioic acid (WR-2721) was shown to provide marked protection against development of radiation-induced leg contractures in C3Hf/Kam mice whose legs were exposed to single doses of gamma-radiation. The radiation doses ranged from 3300 to 6200 rads delivered to the right hind thighs from two parallelly opposed 137Cs sources. WR-2721 was given i.p. 30 min before irradiation. The severity of radiation-induced leg contractures in untreated and WR-2721-treated mice was followed for 342 days after irradiation. The degree of leg contractures in both control and WR-2721-treated mice increased up to 100 days after radiation, when the change stabilized, remaining more or less at the same level to the end of the observation period. During this entire period, the severity of contractures was less in WR-2721-treated mice. The dose-modifying factor for the level of 5 mm reduction in leg extension was 1.5 at 182 days after irradiation. Since WR-2721 did not prevent the radiocurability of 8-mm fibrosarcomas growing in the same legs, these data imply that WR-2721 has a high potential for increasing therapeutic gain when combined with irradiation in the treatment of tumors of an appreciable size.
Hunter, N.; Milas, L.
1. The effects of bepridil, its quaternary derivative: CERM 11888 (methyl-pyrrolidinium bromide) (10(-7)-10(-5) M), and verapamil (10(-7)-10(-6) M) were compared on caffeine-induced contracture of isolated ventricular trabeculae of the ferret. 2. Bepridil diminished the amplitude of contracture in a concentration-dependent fashion, and this effect was significantly different from that of CERM 11888 which, like verapamil, only reduced the amplitude at the highest concentration used. 3. Bepridil (10(-6) M) significantly shortened the time to peak tension and accelerated the relaxation phase of contracture. This latter effect was different from that of CERM 11888. Verapamil (10(-6) M) also tended to accelerate the relaxation phase. At 10(-5) M these actions of bepridil on the time to peak and relaxation tended to reverse. 4. At all concentrations bepridil and verapamil reduced the rate of repriming of contracture and this effect of bedpridil was significantly different from that of its quaternary derivative which only showed a significant effect at 10(-5) M. 5. These results demonstrate a clear intracellular effect of bepridil in the ferret heart. Verapamil and CERM 11888 had only weak intracellular effects even at high concentrations. 6. Analysis of the results suggests that the main sites of action of bepridil in this model are the sarcoplasmic reticulum and one or two calcium compartments in the sarcolemma.
Leboeuf, J.; Leoty, C.; Lamar, J. C.; Massingham, R.
The purpose of this study was to evaluate helical tomotherapy dosimetry in postmastectomy patients undergoing treatment for chest wall and positive nodal regions with simultaneous integrated boost (SIB) in the scar region using strip bolus. Six postmastectomy patients were scanned with a 5-mm-thick strip bolus covering the scar planning target volume (PTV) plus 2-cm margin. For all 6 cases, the chest wall received a total cumulative dose of 49.3-50.4 Gy with daily fraction size of 1.7-2.0 Gy. Total dose to the scar PTV was prescribed to 58.0-60.2 Gy at 2.0-2.5 Gy per fraction. The supraclavicular PTV and mammary nodal PTV received 1.7-1.9 dose per fraction. Two plans (with and without bolus) were generated for all 6 cases. To generate no-bolus plans, strip bolus was contoured and overrode to air density before planning. The setup reproducibility and delivered dose accuracy were evaluated for all 6 cases. Dose-volume histograms were used to evaluate dose-volume coverage of targets and critical structures. We observed reduced air cavities with the strip bolus setup compared with what we normally see with the full bolus. The thermoluminescence dosimeters (TLD) in vivo dosimetry confirmed accurate dose delivery beneath the bolus. The verification plans performed on the first day megavoltage computed tomography (MVCT) image verified that the daily setup and overall dose delivery was within 2% accuracy compared with the planned dose. The hotspot of the scar PTV in no-bolus plans was 111.4% of the prescribed dose averaged over 6 cases compared with 106.6% with strip bolus. With a strip bolus only covering the postmastectomy scar region, we observed increased dose uniformity to the scar PTV, higher setup reproducibility, and accurate dose delivered beneath the bolus. This study demonstrates the feasibility of using a strip bolus over the scar using tomotherapy for SIB dosimetry in postmastectomy treatments.
Rong Yi, E-mail: email@example.com [Department of Human Oncology, University of Wisconsin, Madison, Madison, WI (United States); University of Wisconsin Riverview Cancer Center, Wisconsin Rapids, WI (United States); Yadav, Poonam [Department of Human Oncology, University of Wisconsin, Madison, Madison, WI (United States); Department of Medical Physics, University of Wisconsin, Madison, Madison, WI (United States); Vellore Institute of Technology University, Vellore, Tamil Nadu (India); Welsh, James S. [Department of Human Oncology, University of Wisconsin, Madison, Madison, WI (United States); University of Wisconsin Riverview Cancer Center, Wisconsin Rapids, WI (United States); Department of Medical Physics, University of Wisconsin, Madison, Madison, WI (United States); Fahner, Tasha [University of Wisconsin Riverview Cancer Center, Wisconsin Rapids, WI (United States); Paliwal, Bhudatt [Department of Human Oncology, University of Wisconsin, Madison, Madison, WI (United States); Department of Medical Physics, University of Wisconsin, Madison, Madison, WI (United States)
This research seeks to develop non-invasive burn depth evaluation methods from non-contacting visible and near-infrared spectroscopic measurements. In previous years, we demonstrated that features of the optical reflection spectra of burn wounds can be co...
M. A. Afromowitz J. D. Callis
The U. S. Army Surgical Research Unit uses a standard scald burn of rats for several kinds of studies. This injury is inflicted in anesthetized rats by immersion of the area to be burned in boiling water while the animal is held in a protective template w...
L. Harrel M. S. Walker A. D. Mason
Chemical burn under pneumatic tourniquet is an iatrogenic preventable injury and is rarely reported in the literature. The two important mechanisms are maceration (friction) and wetness underneath the tourniquent. In this report, our experience with two illustrative patients who presented with iatrogenic tourniquet associated burn is described.
Yang, Jae-Hyuk; Lim, Hyungtae; Yoon, Jung-Ro; Jeong, Hyeon-Il
This study evaluated the energy cost of walking (Cw) with knee flexion contractures (FC) simulated with a knee brace, in total knee arthroplasty (TKA) recipients (n=16) and normal controls (n=15), and compared it to baseline (no brace). There was no significant difference in Cw between the groups at baseline but TKA recipients walked slower (P=0.048) and with greater knee flexion in this condition (P=0.003). Simulated FC significantly increased Cw in both groups (TKA P=0.020, control P=0.002) and this occurred when FC exceeded 20° in the TKA group and 15° in the controls. Reported perceived exertion was only significantly increased by FC in the control group (control P<0.001, TKA P=0.058). Simulated knee FCs less than 20° do not increase Cw or perceived exertion in TKA recipients. PMID:23725927
Murphy, Michael T; Skinner, Tina L; Cresswell, Andrew G; Crawford, Ross W; Journeaux, Simon F; Russell, Trevor G
Introduction Many surgical techniques have been advocated to treat Dupuytren’s contracture. Partial fasciectomy is often performed to treat\\u000a the whole spectrum of Dupuytren’s disease.\\u000a \\u000a \\u000a \\u000a Method We have reviewed the effectiveness of total aponeurectomy performed on 61 patients [10 women and 51 men (male:female ratio\\u000a 5.1:1) with a mean age of 63.0 (range 42–79 years) and a mean follow-up of 3.45 years (range 1.03–6.39 years)].\\u000a \\u000a \\u000a \\u000a Results Post-operative
A. Högemann; U. Wolfhard; D. Kendoff; T. N. Board; L. C. Olivier
An adult male bullmastiff dog was treated for paraparesis and ataxia due to discospondylitis and disc herniation. At this time, the dog had a nonhealing ulcer between the pads of the left hindfoot. At re-evaluation, the dog had developed a large exophitic mass in the previously ulcerated area. Cytological examination revealed occasional spindle cells with mild atypia, and a soft tissue tumour was suspected. The mass was excised and submitted for histology. The lesion was characterized by superficial ulceration, an intermediate layer of granulation tissue and a deep portion containing vertically orientated capillaries and perpendicularly arranged fibroblasts and collagen. The histological features led to a diagnosis of hypertrophic scar. Eight weeks after surgery, the lesion recurred and was treated with an intralesional injection of methylprednisolone acetate. The lesion regressed in 10 days, but recurred after 3 months following severe self-trauma. Hypertrophic scars and keloids are two types of exuberant scarring reported in human beings, the pathogenesis of which is still unclear but seems to involve several cytokines, growth factors and inflammatory cells. The histological features identified in this case paralleled those reported in hypertrophic scars in humans. In this case, intralesional corticosteroid therapy was useful in the management of the lesion, but the severe self-trauma could have influenced the recurrence. Even if uncommon, hypertrophic scar should be included among the differential diagnoses of spindle cell tumours in dogs. PMID:21392138
Avallone, Giancarlo; Bonaldi, Martina; Caniatti, Mario; Lombardo, Rocco
Vascular endothelial growth factor (VEGF-A) is known for its effects on endothelial cells and as a positive mediator of angiogenesis. VEGF is thought to promote repair of cutaneous wounds due to its proangiogenic properties, but its ability to regulate other aspects of wound repair, such as the generation of scar tissue, has not been studied well. We examined the role of VEGF in scar tissue production using models of scarless and fibrotic repair. Scarless fetal wounds had lower levels of VEGF and were less vascular than fibrotic fetal wounds, and the scarless phenotype could be converted to a scar-forming phenotype by adding exogenous VEGF. Similarly, neutralization of VEGF reduced vascularity and decreased scar formation in adult wounds. These results show that VEGF levels have a strong influence on scar tissue formation. Our data suggest that VEGF may not simply function as a mediator of wound angiogenesis, but instead may play a more diverse role in the wound repair process. PMID:18427552
Wilgus, Traci A; Ferreira, Ahalia M; Oberyszyn, Tatiana M; Bergdall, Valerie K; Dipietro, Luisa A
In many vertebrate inner ear sensory epithelia, dying sensory hair cells are extruded, and the apices of surrounding supporting cells converge to re-seal the epithelial barrier between the electrochemically-distinct endolymph and perilymph. These cellular mechanisms remain poorly understood. Dynamic microtubular mechanisms have been proposed for hair cell extrusion; while contractile actomyosin-based mechanisms are required for cellular extrusion and closure in epithelial monolayers. The hypothesis that cytoskeletal mechanisms are required for hair cell extrusion and supporting cell scar formation was tested using bullfrog saccules incubated with gentamicin (6 hours), and allowed to recover (18 hours). Explants were then fixed, labeled for actin and cytokeratins, and viewed with confocal microscopy. To block dynamic cytoskeletal processes, disruption agents for microtubules (colchicine, paclitaxel) myosin (Y-27632, ML-9) or actin (cytochalasin D, latrunculin A) were added during treatment and recovery. Microtubule disruption agents had no effect on hair cell extrusion or supporting cell scar formation. Myosin disruption agents appeared to slow down scar formation but not hair cell extrusion. Actin disruption agents blocked scar formation, and largely prevented hair cell extrusion. These data suggest that actin-based cytoskeletal processes are required for hair cell extrusion and supporting cell scar formation in bullfrog saccules.
Hordichok, Andrew J.; Steyger, Peter S.
Atrophic facial acne scarring is a widely prevalent condition that can have a negative impact on a patient's quality of life. The appearance of these scars is often worsened by the normal effects of aging. A number of options are available for the treatment of acne scarring, including chemical peeling, dermabrasion, ablative or nonablative laser resurfacing, dermal fillers, and surgical techniques such as subcision or punch excision. Depending on the type and extent of scarring, a multimodal approach is generally necessary to provide satisfactory results. Resurfacing techniques correct surface irregularities, long-lasting dermal fillers address the volume loss resulting from acne, and sub-superficial musculoaponeurotic system (SMAS) face-lift procedures counter the soft tissue laxity and ptosis associated with aging. This article briefly reviews the evolution of individual approaches to treating atrophic acne scarring, followed by case examples illustrating results that can be achieved using a multimodal approach. Representative cases from patients in their 30s, 40s, and 50s are presented. In the author's clinical practice, multimodal approaches incorporating fractionated laser, injectable poly-L: -lactic acid, and sub-SMAS face-lift procedures have achieved optimal aesthetic outcomes, high patient satisfaction, and durability of aesthetic effect over time. PMID:21491169
O'Daniel, T Gerald
Severe chemical burns of the ocular surface frequently result in long-standing and ongoing disorders of the conjunctiva and the cornea including conjunctival scarring with shortening of the fornix, cicatricial entropion, complications caused by trichiasis and scarring or chronic ulceration of the cornea. Advanced destruction of limbal stem cells leads to limbal stem cell deficiency with conjunctivalization of the cornea. Surgical therapy aims at the correction of malpositioning of the lids, the reconstruction of the conjunctiva and the fornix utilizing applicable tissue grafts and the reestablishment of a stable, avascular and transparent corneal epithelium by e.g. transplantation of epithelial stem cells. Progressive corneal ulcerations unresponsive to medical therapy can be treated by amniotic membrane transplantation, corneal transplantation or by conjunctival covering depending on the extent of damaged tissue. The surgical therapy of patients after severe chemical burns of the ocular surface is generally performed in specialized centers and occasionally requires a multidisciplinary approach. PMID:22037726
Bachmann, B; Cursiefen, C
The aims of this study were to adapt the Body Image Quality of Life Inventory (BIQLI) into Brazilian Portuguese (BP) and to assess the psychometric properties of the adapted version. Construct validity was assessed by correlating the BIQLI-BP scores with the Rosenberg's Self-Esteem Scale, with Burns Specific Health Scale-Revised (BSHS-R), and with gender, total body surface area burned, and visibility of the scars. Participants were 77 adult burn patients. Cronbach's alpha for the adapted version was .90 and moderate linear correlations were found between body image and self-esteem and between BIQLI-BP scores and two domains of the BSHS-R: affect and body image and interpersonal relationships. The BIQLI-BP showed acceptable levels of reliability and validity for Brazilian burn patients. PMID:23494960
Assunção, Flávia Fernanda Oliveira; Dantas, Rosana Aparecida Spadoti; Ciol, Márcia Aparecida; Gonçalves, Natália; Farina, Jayme Adriano; Rossi, Lidia Aparecida
This paper estimates the two-daily extent of savanna burning and consumption of fine (grass and litter) fuels from an extensive 230,000 km2 region of northern Australia during August-September 1999 encompassing the Australian continental component of the Biomass Burning and Lightning Experiment B (BIBLE B) campaign [, 2002]. The extent of burning for the study region was derived from fire scar mapping of imagery from the advanced very high resolution radiometer (AVHRR) on board the National Oceanic and Atmospheric Administration (NOAA) satellite. The mapping was calibrated and verified with reference to one Landsat scene and associated aerial transect validation data. Fine fuel loads were estimated using published fuel accumulation relationships for major regional fuel types. It is estimated that more than 43,000 km2 was burnt during the 25 day study period, with about 19 Mt of fine (grass and litter) fuels. This paper examines assumptions and errors associated with these estimates. It is estimated from uncalibrated fire mapping derived from AVHRR imagery that 417,500 km2 of the northern Australian savanna was burnt in 1999, of which 136,405 km2, or 30%, occurred in the Northern Territory study region. Using generalized fuel accumulation equations, such biomass burning consumed an estimated 212.3 Mt of fine fuels, but no data are available for consumption of coarse fuels. This figure exceeds a recent estimate, based on fine fuels only, for the combined Australian savanna and temperate grassland biomass burning over the period 1990-1999 but is lower than past estimates derived from classification approaches. We conclude that (1) fire maps derived from coarse-resolution optical imagery can be applied relatively reliably to estimate the extent of savanna fires, generally with 70-80% confidence using the approach adopted here, over the major burning period in northern Australia and (2) substantial further field assessment and associated modeling of fuel accumulation, especially of coarse fuels, is required.
Russell-Smith, Jeremy; Edwards, Andrew C.; Cook, Garry D.
Conventional suture technique in the reconstruction of the bile duct often result in anastomotic stenosis and eventual obstructive jaundice and biliary cirrhosis. To overcome the aforementioned drawbacks, fibrin glue (FG) was used instead in the biliointestinal anastomosis where indwelling stent was inserted to complete the experimental model. The experiment consisted of pathological study and ECVD evaluation of anastomotic specimens in order to follow up the whole process of anastomotic wound healing. The experimental studies dis-closed that FG promotes wound healing, limits scar formation, and accelerates scar softening and maturnation. FG plus 6-month indwelling stent can guarantee scar maturation. It is an effective method in the prevention of bile duct stricture. PMID:10374531
Zhang, L; Zhou, L; Xue, Z
SCAR, the Scientific Committee on Antarctic Research, is, like the IAU, a committee of ICSU, the International Council for Science. For over 30 years, SCAR has provided scientific advice to the Antarctic Treaty System and made numerous recommendations on a variety of matters. In 2010, Astronomy and Astrophysics from Antarctica was recognized as one of SCAR's five Scientific Research Programs. Broadly stated, the objectives of Astronomy & Astrophysics from Antarctica are to coordinate astronomical activities in Antarctica in a way that ensures the best possible outcomes from international investment in Antarctic astronomy, and maximizes the opportunities for productive interaction with other disciplines. There are four Working Groups, dealing with site testing, Arctic astronomy, science goals, and major new facilities. Membership of the Working Groups is open to any professional working in astronomy or a related field.
Storey, John W. V.; Abe, Lyu; Andersen, Michael; Anderson, Philip; Burton, Michael; Cui, Xiangqun; Ichikawa, Takashi; Karle, Albrecht; Lloyd, James; Masi, Silvia; Steinbring, Eric; Travouillon, Tony; Tuthill, Peter; Zhou, HongYang
The World Health Organization recommends Mycobacterium bovis BCG vaccination in areas of high tuberculosis prevalence. BCG's clinical and immune effects, not necessarily Mycobacterium tuberculosis specific, are unclear. BCG vaccine scarring often is used as a surrogate marker of vaccination or of effective vaccination. We evaluated BCG scarring status in relation to clinical findings and outcome in 700 hospitalized Malawians, of whom 32 had M. tuberculosis bloodstream infections (BSI) (10 of whom had cellular immune studies done) and of whom 48 were infants <6 months old and therefore recently vaccinated (19 of whom had immune studies). In the patients ?6 months old, scarring was not related to the presence of pulmonary symptoms (35 versus 30%), chronic cough or fever, mortality, or M. tuberculosis BSI. In M. tuberculosis BSI patients, scarring was unrelated to mortality, vital signs, or clinical symptoms but those with scarring had higher proportions of memory and activated T cells and more type 2-skewed cytokine profiles. Infants with either BCG scarring (n = 10) or BCG lesional inflammation (n = 5) had no symptoms of sepsis, but 18 of 33 infants without BCG vaccination lesions did. Those with BCG lesions had localized infections more often than did those without BCG lesions. These infants also had lower median percentages of lymphocytes spontaneously making interleukin-4 (IL-4) or tumor necrosis factor alpha (TNF-?) and lower ratios of T cells spontaneously making IL-4 to T cells making IL-6. Thus, we found that, in older patients, BCG vaccine scarring was not associated with M. tuberculosis-specific or nonspecific clinical protection. Those with M. tuberculosis BSI and scarring had immune findings suggesting previous M. tuberculosis antigen exposure and induction of a type 2 cytokine pattern with acute reexposure. It is unlikely that this type 2 pattern would be protective against mycobacteria, which require a type 1 response for effective containment. In infants <6 months old, recent BCG vaccination was associated with a non-M. tuberculosis-specific, anti-inflammatory cytokine profile. That the vaccinated infants had a greater frequency of localized infections and lesser frequency of sepsis symptoms suggests that this postvaccination cytokine pattern may provide some non-M. tuberculosis-specific clinical benefits.
Jason, Janine; Archibald, Lennox K.; Nwanyanwu, Okey C.; Kazembe, Peter N.; Chatt, Julie A.; Norton, Elizabeth; Dobbie, Hamish; Jarvis, William R.
In the last decade, diagnosis of caesarean scar (CS) pregnancy and abnormal placental invasion has gone up significantly. It appears that the history of previous caesarean section is the predisposing factor common to both conditions. Until now, these are treated as a separate entity and therefore managed differently. Recent available evidence suggests that these are not a separate entity but rather a continuum of the same condition. If the caesarean scar pregnancy is managed expectantly in the 1st trimester, most likely it evolves into placenta accreta. This leads invariably to peripartum hysterectomy for postpartum haemorrhage (PPH) and severe maternal morbidity. Early diagnosis and intervention may give a favourable outcome. PMID:22943704
Sinha, P; Mishra, M
Burn injury is one of the most traumatic injuries a child or adolescent can experience. When a burn injury occurs, the child can suffer pain, uncertainty, fear, and trauma from acute treatment to rehabilitation and reintegration. He or she can also experience long-term psychosocial and psychological difficulties. The objective of the study was to compare health-related quality of life (HRQoL), psychopathology, and self-concept of children who have suffered a burn injury with a matched sample of healthy controls. Sixty-six children and adolescents with a burn injury, who were aged between 8 to 17 years, and a caregiver were recruited from six burn centers in Australia and New Zealand. Participants completed the Paediatric Quality of Life Inventory, the Strengths and Difficulties Questionnaire, and the Piers-Harris Self-Concept Scale (P-H SCS). Scores were compared with published normative data. As scarring and appearance are a distinct issue, the Paediatric Quality of Life Inventory cancer module perceived physical appearance subscale was also included. Pediatric burn survivors and their caregivers reported significantly higher emotional and behavioral problems and lower HRQoL, but no significant differences in self-concept compared with healthy counterparts. Pediatric burn survivors also reported significantly poorer perceived physical appearance than the matched pediatric cancer sample. Burned children reported lowered quality of life, particularly related to scarring and appearance; however, they reported normative self-concept. This may be because of self-concept being a psychological trait, whereas HRQoL is influenced by societal norms and expectations. Psychosocial support is necessary to build positive coping strategies and manage the unpleasant social experiences that may reduce quality of life. PMID:23702857
Maskell, Jessica; Newcombe, Peter; Martin, Graham; Kimble, Roy
Hypertrophic scarring (HS) has been considered as a great concern for patients and a challenging problem for clinicians as it can be cosmetically disfiguring and functionally debilitating. In this study, Ginsenoside Rg3/Poly(l-lactide) (G-Rg3/PLLA) electrospun fibrous scaffolds covering on the full-thickness skin excisions location was designed to suppress the hypertrophic scar formation in vivo. SEM and XRD results indicated that the crystal G-Rg3 carried in PLLA electrospun fibers was in amorphous state, which facilitates the solubility of G-Rg3 in the PLLA electrospun fibrous scaffolds, and solubility of G-Rg3 in PBS is increased from 3.2 µg/ml for pure G-Rg3 powders to 19.4 µg/ml for incorporated in PLLA-10% fibers. The released G-Rg3 content in the physiological medium could be further altered from 324 to 3445 µg in a 40-day release period by adjusting the G-Rg3 incorporation amount in PLLA electrospun fibers. In vitro results demonstrated that electrospun G-Rg3/PLLA fibrous scaffold could significantly inhibit fibroblast cell growth and proliferation. In vivo results confirmed that the G-Rg3/PLLA electrospun fibrous scaffold showed significant improvements in terms of dermis layer thickness, fibroblast proliferation, collagen fibers and microvessels, revealing that the incorporation of the G-Rg3 in the fibers prevented the HS formation. The above results demonstrate the potential use of G-Rg3/PLLA electrospun fibrous scaffolds to rapidly minimize fibroblast growth and restore the structural and functional properties of wounded skin for patients with deep trauma, severe burn injury, and surgical incision. PMID:23874757
Cui, Wenguo; Cheng, Liying; Hu, Changmin; Li, Haiyan; Zhang, Yuguang; Chang, Jiang
This research seeks to develop non-invasive techniques for evaluating burn depth based upon non-contacting visible and near-infrared spectroscopic measurement of the wounds. In previous years, we demonstrated that features of the optical reflection spectr...
J. B. Callis M. A. Afromowitz
New carborane burning rate accelerators designed for use in solid propellants, without the problems associated with current accelerators, have been prepared. High molecular weight, non-volatile derivatives of bis(1-carboranylmethyl) and bis-(1-carboranyle...
R. Fitzgerald L. J. Rosen R. L. Lou
This monograph summarizes the experiences of treating persons suffering from burns which have been accumulated by the collective of the hospital surgical clinic of the Samarkand Medical Institute, and also uses the data of the modern literature concerning...
S. A. Mullakandov
Small and moderate scalds in toddlers are still the most frequent thermal injuries the pediatric surgeons have to face today. Over the last years, surgical treatment of these patients has changed in many aspects. Due to new dressing materials and new surgical treatment strategies that are particularly suitable for children, today, far better functional and aesthetic long-term results are possible. While small and moderate thermal injuries can be treated in most European pediatric surgical departments, the severely burned child must be transferred to a specialized, ideally pediatric, burn center, where a well-trained multidisciplinary team under the leadership of a (ideally pediatric) burn surgeon cares for these highly demanding patients. In future, tissue engineered full thickness skin analogues will most likely play an important role, in pediatric burn as well as postburn reconstructive surgery. PMID:24026780
Schiestl, Clemens; Meuli, Martin; Trop, Marija; Neuhaus, Kathrin
Burns caused by prolonged contact of wet cement with skin are common in this country. Recent literature has highlighted other ways in which the use and manufacture of cement can lead to burn injuries, notably through explosion and contact with hot powder during manufacturing. These injuries are uncommon in this country and potentially very serious. Case studies are presented of two men injured in such a way in the same incident at a cement-manufacturing plant. PMID:8982549
Morley, S E; Humzah, D; McGregor, J C; Gilbert, P M
Summary Burn injuries continue to be a major source of mortality and morbidity in low- and middle-income countries of the world, of which Nigeria is a part. Overview data on burn care in Nigeria are sparse but the available literature on burns and burn care in Nigeria was retrieved through Internet-based search engines, collated, and reviewed. Peculiarities of epidemiology, types of burn, pattern of injuries, complications, and outcome of burn care were reviewed. There were no broad-based overview statistical data on burns in Nigeria in all the articles reviewed. There was no documentation on the regionalization of care and there were no national databases. All reports on epidemiology were hospital-based. Flame is emerging as the predominant cause of burns, and burn injury is occurring increasingly away from the domestic setting. The severity of the injuries is also increasing. Deliberate burn injury remains a practice and a wide range of complications occur as burns sequelae in Nigeria. Several challenges militate against optimal care for burn victims. Burn injuries continue to contribute significantly to the burden of disease in Nigeria. There is a need for broad-based data collection systems. Avoidable complications are common and mortality remains high. Pooling of resources by regionalization of care could increase focus on burn prevention and improve the care of burn victims. Nongovernmental and governmental support to reduce the burden of burns is advocated.
Oladele, A.O.; Olabanji, J.K.
It is estimated that PBXN-110 will burn laminarly with a burn function of B = (0.6-1.3)*P(sup 1.0) (B is the burn rate in mm/s and P is pressure in MPa). This paper provides a brief discussion of how this burn behavior was estimated.
The media have a profound influence on the actions of children and adults. Burns and burn prevention tend to be ignored or even mocked. The purpose of this presentation is to reveal the callousness of the media in its dealings with burns and burn prevention. Printed materials with a relationship to burns, risk of burning, or disrespect for the consequences of burns were collected. The materials were tabulated into four categories: comics, advertisements (ads), articles that made light of burns, and television shows that portrayed behavior that would risk burn injury. Most burn-related materials were found in comics or advertisements. Several comics made light of high-risk behavior with flames, scald injury, contact injury, or burns. In addition, several advertisements showed people on fire or actions that could easily lead to burns. Several articles and televisions shows portrayed high-risk behavior that, in some instances, led to copycat injuries. Flames are frequently used to sell items that target adolescent boys or young men. The high incidence injuries that frequent this population parallel the high-risk behaviors portrayed by the media. The media portrays flames and high-risk behavior for burn injury as being cool, funny, and without consequence. The use of flames on clothing and recreational equipment (skateboards, hot rods) particularly targets the high-risk adolescent male. The burn community should make the media aware of the harm it causes with its callous depiction and glorification of burns. PMID:12792237
Greenhalgh, David G; Palmieri, Tina L
Ball lightning is a rare physical phenomenon, which is not yet completely explained. It is similar to lightning but with different, peculiar characteristics. It can be considered a mix of fire and electricity, concentrated in a fireball with a diameter of 20-cm that most commonly appears suddenly, even in indoor conditions, during a thunderstorm. It moves quickly for several meters, can change direction, and ultimately disappears. During a great storm, a 28-year-old man and his 5-year-old daughter sustained burn wounds after ball lightning came from the outdoors through a chimney. These two patients demonstrated signs of fire and electrical injuries. The father, who lost consciousness, sustained superficial second-degree burn wounds bilaterally on the zygomatic area and deep second-degree burn wounds on his right hand (total body surface area, 4%). His daughter demonstrated superficial second-degree burn wounds on the left part of the face and deep second-degree and third-degree burn wounds (total body surface area, 30%) on the left neck, both upper arms, and the back. In this article, the authors report the first two cases of burn injuries resulting from ball lightning contact indoors. The literature on this rare phenomenon is reviewed to elucidate the nature of ball lightning. Emphasis is placed on the nature of injuries after ball lightning contact, the therapy used, and the long-term complications. PMID:12792547
Selvaggi, Gennaro; Monstrey, Stan; von Heimburg, Dennis; Hamdi, Mustapha; Van Landuyt, Koen; Blondeel, Phillip
According to the authors, a new marking design for vertical scar breast reduction avoids the tension at nipple level that may occur with the use of a mosque-shaped marking (Lejour technique). Furthermore, better symmetry may be achieved in placement of the areola and nipple. PMID:19336153
Serra-Renom, José María; Fontdevila, Joan
AIMS--This study aimed to evaluate stromal wound healing morphology in short term unsutured compared with sutured corneal wounds, to define regional variation in healing within radial keratotomy wounds. METHODS--Stromal scar tissue orientation (fibroblast and collagen fibre orientation) was analysed in unsutured and adjacent sutured keratotomy wounds in monkeys, 2 to 9 weeks after surgery, using light and transmission electron microscopy.
G. R. J. Melles; P. S. Binder; W. Houdijn Beekhuis; R. H. J. Wijdh; M. N. Moore; J. A. Anderson; N. SundarRaj
Existing remote sensing-based Burnt scar mapping methodologies are mainly based on medium spatial resolution sensors. These methodologies cannot accurately detect burnt areas smaller than 200 ha. However, smaller burnt areas can represent a significant number of the total burnt areas. They play an important ecological roll, and also have relevant socio-economic consequences. Within this framework, a new methodology for burnt
Fernando Sedano; Pieter Kempeneers; Jan Kucera; Jesus San Miguel-Ayanz
Disciform scars secondary to age-related macular degeneration were surgically removed in three patients. Postoperative visual acuity improved minimally in one case and decreased in the other two cases. The results suggest further investigation is needed with possible modifications of our technique for future studies. PMID:1917314
Blinder, K J; Peyman, G A; Paris, C L; Gremillion, C M
9. VIEW OF BASIN BEHIND DAM, SHOWING SCARS FROM EARTH MOVING TO CONSTRUCT DAM, LOOKING EAST - High Mountain Dams in Upalco Unit, East Timothy Lake Dam, Ashley National Forest, 8.4 miles North of Swift Creek Campground, Mountain Home, Duchesne County, UT
8. VIEW OF BASIN BEHIND DAM, SHOWING SCARS FROM EARTH MOVING TO CONSTRUCT DAM, LOOKING NORTH - High Mountain Dams in Upalco Unit, East Timothy Lake Dam, Ashley National Forest, 8.4 miles North of Swift Creek Campground, Mountain Home, Duchesne County, UT
4. VIEW OF DOWNSTREAM FACE OF DAM, WITH SCARS FROM EARTH MOVING TO CONSTRUCT DAM IN FOREGROUND, LOOKING NORTHWEST - High Mountain Dams in Upalco Unit, Five Point Lake Dam, Ashley National Forest, 12 miles Northwest of Swift Creek Campground, Mountain Home, Duchesne County, UT
Traumatic injury to the adult mammalian CNS results in the formation of an astroglial-mesenchymal scar that seals the wound site but blocks axonal regeneration in the process. The mechanism that leads to this inhibition of axon out- growth has been proposed to be either a physical barrier blocking the advancement of the growth cone or chemical factors actively inhibiting axon
John S. Rudge; Jerry Silver
Boiler tubes in a fossil-fuelled power station are subjected to erosion and corrosion that caused the tubes to become locally thinned or scarred. To avoid unscheduled tube failures and hence prevent large financial loss due to boiler shut-down and tube repairs, it is important to estimate boiler tube lives. Boiler tube lives are very sensitive to tube temperature. This paper
Japanese men long resident in Honolulu, Hawaii have significantly more ischemic heart disease, but significantly fewer small cardiac scars than men in Hiroshima, Japan. These scars occur in three forms: (1) small scars in the mural myocardium which accoun...
A. Steer S. S. Lee G. N. Stemmermann T. Yamamoto G. G. Rhoads
In unilateral congenital superior oblique palsy, a large hypertropia is sometimes associated with ipsilateral contracture of the superior rectus muscle and apparent overaction of the contralateral superior oblique. Ipsilateral double elevator weakening is one surgical approach; however, this procedure could compromise supraduction. We report a series of three consecutive patients who underwent ipsilateral superior rectus and inferior oblique recessions for unilateral superior oblique palsy. Intraoperatively, all three patients were found to have a lax ipsilateral superior oblique tendon. Postoperatively, all three patients had satisfactory correction of the hypertropia and abnormal head position with minimal supraduction defect. This procedure seems to be an acceptable initial surgical option for treating congenital superior oblique muscle palsy with ipsilateral contracture of the superior rectus muscle, even when the ipsilateral superior oblique tendon is lax. PMID:22681951
Khan, Arif O
We report on a case of a 67-year-old man who presented with persistent lower urinary tract symptoms following a potassium titanyl phosphate laser photoselective vaporization of prostate. Upon further diagnostic examinations were performed, he was noted to have an obliterative bladder neck contracture with an incidental, misleading, and rare presence of an unroofed midline anterior prostatic cyst presenting as a stricture. As we were presented with this case, it was imperative to address these complications of bladder neck contracture and incompletely ablated prostatic cyst. This report brings to light underestimated complicating factors in the urinary tract, and the diagnostic and therapeutic interventions we had undertaken to rectify the identified complications and improve patien's quality of life. The patient underwent internal urethrotomy, resection of prostatic cyst wall and transurethral resection of the prostate directed to improve his quality of life and prevent urinary retention.
Diaz, Richilda Red; Lee, Joo Yong; Choi, Young Deuk
The purpose of this study was to evaluate helical tomotherapy dosimetry in postmastectomy patients undergoing treatment for chest wall and positive nodal regions with simultaneous integrated boost (SIB) in the scar region using strip bolus. Six postmastectomy patients were scanned with a 5-mm-thick strip bolus covering the scar planning target volume (PTV) plus 2-cm margin. For all 6 cases, the chest wall received a total cumulative dose of 49.3-50.4 Gy with daily fraction size of 1.7-2.0 Gy. Total dose to the scar PTV was prescribed to 58.0-60.2 Gy at 2.0-2.5 Gy per fraction. The supraclavicular PTV and mammary nodal PTV received 1.7-1.9 dose per fraction. Two plans (with and without bolus) were generated for all 6 cases. To generate no-bolus plans, strip bolus was contoured and overrode to air density before planning. The setup reproducibility and delivered dose accuracy were evaluated for all 6 cases. Dose-volume histograms were used to evaluate dose-volume coverage of targets and critical structures. We observed reduced air cavities with the strip bolus setup compared with what we normally see with the full bolus. The thermoluminescence dosimeters (TLD) in vivo dosimetry confirmed accurate dose delivery beneath the bolus. The verification plans performed on the first day megavoltage computed tomography (MVCT) image verified that the daily setup and overall dose delivery was within 2% accuracy compared with the planned dose. The hotspot of the scar PTV in no-bolus plans was 111.4% of the prescribed dose averaged over 6 cases compared with 106.6% with strip bolus. With a strip bolus only covering the postmastectomy scar region, we observed increased dose uniformity to the scar PTV, higher setup reproducibility, and accurate dose delivered beneath the bolus. This study demonstrates the feasibility of using a strip bolus over the scar using tomotherapy for SIB dosimetry in postmastectomy treatments. PMID:22365416
Rong, Yi; Yadav, Poonam; Welsh, James S; Fahner, Tasha; Paliwal, Bhudatt
This bibliography documents 292 publications of the Supersonic Cruise Aircraft Research (SCAR) program published during the first four years of effort. The reports are arranged according to SCAR discipline: system studies, propulsion, stratospheric emissi...
Burn victims, especially children, with visible scarring and other resultant deformities have significant changes in self-esteem, happiness, and satisfaction. Therefore, whatever we can do to improve their appearance is extremely important and rewarding. We used a different technique in the case. Detailed technique is discussed within the text. PMID:18650710
Emsen, Ilteris Murat
We present a modification to the widely used lead hand retraction system that allows for improved surgical access to a digit with a severe flexor contracture. A simple construct using surgical adhesive tape and a silk suture can be made and applied to the digit and lead hand. Our technique is simple and inexpensive to use, and we recommend its use to improve surgical access without causing unnecessary trauma to the digit. PMID:20961699
Jain, Sameer; Anwar, Mohammed Umair; Majumder, Sanjib
Our objective is to describe the natural history of motion loss with time and myofibroblast numbers in a rabbit knee model of post-traumatic joint contractures. Twenty-eight skeletally mature New Zealand White female rabbits had five-mm-squares of cortical bone removed from the medial and lateral femoral condyles of the right knee. A Kirschner wire (K-wire) was used to immobilize the knee
Kevin A. Hildebrand; Craig Sutherland; Mei Zhang
This paper presents results of the AQL2004 project, which has been develope within the GOFC-GOLD Latin American network of remote sensing and forest fires (RedLatif). The project intended to obtain monthly burned-land maps of the entire region, from Mexico to Patagonia, using MODIS (moderate-resolution imaging spectroradiometer) reflectance data. The project has been organized in three different phases: acquisition and preprocessing of satellite data; discrimination of burned pixels; and validation of results. In the first phase, input data consisting of 32-day composites of MODIS 500-m reflectance data generated by the Global Land Cover Facility (GLCF) of the University of Maryland (College Park, Maryland, U.S.A.) were collected and processed. The discrimination of burned areas was addressed in two steps: searching for "burned core" pixels using postfire spectral indices and multitemporal change detection and mapping of burned scars using contextual techniques. The validation phase was based on visual analysis of Landsat and CBERS (China-Brazil Earth Resources Satellite) images. Validation of the burned-land category showed an agreement ranging from 30% to 60%, depending on the ecosystem and vegetation species present. The total burned area for the entire year was estimated to be 153 215 km2. The most affected countries in relation to their territory were Cuba, Colombia, Bolivia, and Venezuela. Burned areas were found in most land covers; herbaceous vegetation (savannas and grasslands) presented the highest proportions of burned area, while perennial forest had the lowest proportions. The importance of croplands in the total burned area should be taken with reserve, since this cover presented the highest commission errors. The importance of generating systematic products of burned land areas for different ecological processes is emphasized. PMID:18372556
Chuvieco, Emilio; Opazo, Sergio; Sione, Walter; Del Valle, Hector; Anaya, Jesús; Di Bella, Carlos; Cruz, Isabel; Manzo, Lilia; López, Gerardo; Mari, Nicolas; González-Alonso, Federico; Morelli, Fabiano; Setzer, Alberto; Csiszar, Ivan; Kanpandegi, Jon Ander; Bastarrika, Aitor; Libonati, Renata
Radial scars are getting more and more common since the implementation of mammography as a diagnostic tool in screening women for breast cancer. At the Karolinska Hospital, 18,987 asymptomatic women, between the ages of 50 and 69, were screened for breast cancer by means of mammography during the period August 1989 to May 1991. A total of 735 (3.87%) women were recalled for additional views after initial mammograms and 463 (2.44%) were assessed with the help of cytology. In all 175 (0.92%) women were selected for surgery and 146 (0.77%) had histologically verified cancers. The remaining 29 (0.15%) had non-malignant lesions of which 11 (0.06%) were radial scars. All radial scars were diagnosed on mammograms and later confirmed with histology. The radiologic characteristics were found to be (a) rather thick and long radiating structures accompanied by radiolucent linear structures parallel to some of the spicules, (b) absence of calcifications, (c) radiolucent areas in the central body of the lesion, (d) an average mean size of 6 mm and (e) changing image in different views. Most of the lesions, 73% (8/11), were in moderately dense breasts and there was no specific relation to the right or left breast. A majority of radial scars, 64% (7/11), were found in the upper outer quadrants, 27% (3/11) in the lower outer quadrants and 9% (1/11) in the lower inner quadrant. Literature shows that histology uses many synonyms for radial scars and therefore team work between the radiologists and pathologists is suggested for better conformity of the diagnosis. PMID:1396782
Azavedo, E; Svane, G
In Canada, Dupuytren's contracture is managed with partial fasciectomy or percutaneous needle aponeurotomy (PNA). Injectable collagenase will soon be available. The optimal management of Dupuytren's contracture is controversial and trade-offs exist between the different methods. Using a cost-utility analysis approach, our aim was to identify the most cost-effective form of treatment for managing Dupuytren's contracture it and the threshold at which collagenase is cost-effective. We developed an expected-value decision analysis model for Dupuytren's contracture affecting a single finger, comparing the cost-effectiveness of fasciectomy, aponeurotomy and collagenase from a societal perspective. Cost-effectiveness, one-way sensitivity and variability analyses were performed using standard thresholds for cost effective treatment ($50 000 to $100 000/QALY gained). Percutaneous needle aponeurotomy was the preferred strategy for managing contractures affecting a single finger. The cost-effectiveness of primary aponeurotomy improved when repeated to treat recurrence. Fasciectomy was not cost-effective. Collagenase was cost-effective relative to and preferred over aponeurotomy at $875 and $470 per course of treatment, respectively. In summary, our model supports the trend towards non-surgical interventions for managing Dupuytren's contracture affecting a single finger. Injectable collagenase will only be feasible in our publicly funded healthcare system if it costs significantly less than current United States pricing. PMID:23908426
Baltzer, H; Binhammer, P A
Compartment syndrome affecting the upper limb is reported rarely in the literature and is usually limited to single case reports. Upper limb compartment syndrome secondary to envenomation is rare, especially in the UK. Worldwide, it has been reported resulting from snake and insect bites, mostly from snakes from the Viperidae family, and from insects such as bees and wasps. Reports from the UK are limited to one case of an adder bite. We present a case of a previously fit and well adult who developed an ischaemic contracture of the forearm after an insect bite. Surgical exploration revealed segmental necrosis and contracture of the superficial and deep flexors of the fingers, requiring fasciotomy and tendon-lengthening procedures. This is the first report of a compartment syndrome, or a late ischaemic contracture from an insect bite in the UK. Owing to the rarity of compartment syndrome of the upper limb secondary to envenomation, a delay in diagnosis and treatment can lead to irreversible changes in the muscular compartments of the forearm. PMID:23484979
Hardwicke, J; Srivastava, S
The etiology and treatment of hypertrophic scar remain puzzles even after decades of research. A significant reason is the lack of an accepted animal model of the process. The female, red Duroc pig model was described long ago. Since the skin of the pig is similar to that of humans, we are attempting to validate this model and found it
Nobuyuki Harunari; Kathy Q. Zhu; Rebecca T. Armendariz; Heike Deubner; Pornprom Muangman; Gretchen J. Carrougher; F. Frank Isik; Nicole S. Gibran; Loren H. Engrav
The scar effect is the phenomenon whereby energy eigenstates display enhancement structures resembling the path of unstable periodic orbits for the corresponding classical system. This paper deals with collision states in charged three-body problems in periodic media, which are scarred by unstable classical orbits. With resonant excitation, the scar effect may be used to reach and stabilize configurations which classically
R. Vilela Mendes; Grupo de F ´ õsica-Matematica
Typhlodromus pyri Scheuten (Acari: Phytoseiidae) is the most important predator of Panonychus ulmi (Koch) (Acari: Tetranychidae) in orchards and vineyards. It was recently found that adult T. pyri females cause microscopic scars on apple leaves. The present laboratory experiments were carried out to confirm the production\\u000a of scars on apple leaves and to assess if females cause scars on fruits
C. Sengonca; I. A. Khan; P. Blaeser
The lesion scar formed after CNS injury is an impediment to axonal regeneration and leads to growth arrest or misrouting of sprouting axons. Our previous study showed that pharmacological reduction of basal membrane formation within the scar can overcome this scar impermeability [Stichel C. C. et al. (1999) Eur. J. Neurosci. 11, 632–646]. The aim of the present study was
C. C. Stichel; H. Niermann; D. d'Urso; F. Lausberg; S. Hermanns; H. W. Müller
Topical self drying silicone gel is a relatively recent treatment modality promoted as an alternative to topical silicone gel sheeting. Thirty patients with scars of different types including superficial scars, hypertrophic scars, and keloids were treated with silicon gel application. The results of the self-drying silicone gel have been satisfactory.
Puri, Neerja; Talwar, Ashutosh
Methods Two cohorts (A and B) were used to describe the mortality pattern for children with and without BCG scar and to determine specific causes of death. In cohort A (n = 1813), BCG scar was assessed at 6 months of age and as previously described children with a BCG scar had lower mortality over the next 12 months than
Adam Roth; Per Gustafson; Alexandro Nhaga; Queba Djana; Anja Poulsen; May-Lill Garly; Henrik Jensen; Morten Sodemann; Amabelia Rodriques; Peter Aaby
The care of burns to the head, face, and neck remains a challenge to the clinician. From 1978 to 1986, halo traction was used as an immobilizing device and as a protective frame for 31 patients with burns to the head (n = 8), face (n = 24), and neck (n = 28). The patients ranged in age from 8 months to 80 years (mean = 16 years) and had second- and third-degree burns covering a total body surface area of 8% to 75% (mean = 28%). The halo was used for an average of eight days (range one to 19 days) and served to immobilize and protect areas of fresh skin grafts, as well as to elevate and protect scalp donor sites (n = 10). Traction was initially used in patients who were confused and uncooperative, and in patients whose burns involved the neck to provide extension for prophylaxis against contractures. Treatment side effects included intermittent headache and backache, the latter occurring especially in the patients subjected to hyperextension. Eight patients (26%) complained of discomfort, which was reduced with adequate analgesia, sedation, and emotional support. The halo had to be removed from one patient after one day because of a loose pin, and in another patient after eight days because of the development of cellulitis at a pin site. Halo immobilization was used successfully to minimize graft loss in 30 of 31 patients. PMID:3283135
Schubert, W; Kuehn, C; Moudry, B; Miyamoto, S; Ahrenholz, D H; Solem, L D
We address the clinical application of the suspension type cultured epithelial autografts (CEAs), Keraheal™ (MCTT, Seoul, Korea), along with the effects, application method, merits and demerits thereof. From February 2007 to June 2010, 29 burn patients with extensive burns, participated in the suspension type of CEA clinical test. A widely meshed autograft (1:4-6 ratio) was applied to the wound bed and the suspension type CEA was sprayed with a Tissomat cell sprayer, followed by a Tissucol spray, a fibrin sealant. The patients' (men/women=26/3) median (interquartile ranges) age was 42 (30-49) years old, the burned TBSA was 55 (44-60) %, and the full thickness burn area was 40 (30-46.5) %. The area of Keraheal™ applied was 800 (400-1200) cm(2). The take rate was 96 (90.5-99) % and 100 (98.5-100) % at 2 and 4 weeks after treatment with Keraheal™, respectively. The Vancouver burn scar scale was 5 (4-6.5), 4 (3-6), and 3 (2-4) at 8, 12 and 24 weeks after the Keraheal™ application. Widely meshed autograft must be applied in massive burns but it's take rate is greatly reduced. The CEAs enhance the take rate of a wide meshed autograft in massive burns and allow for grafting wide meshed autograft together with acellular dermal matrix in some cases. PMID:21531079
Yim, Haejun; Yang, Hyeong Tae; Cho, Yong Suk; Seo, Cheong Hoon; Lee, Boung Chul; Ko, Jang Hyu; Kwak, In Suk; Kim, Dohern; Hur, Jun; Kim, Jong Hyun; Chun, Wook
The effect of confined burning explosive abutting nonburning explosive in a variety of one-dimensional geometries has been studied by numerical simulation, demonstrating the effects of confinement, burning rate, and shock sensitivity. The model includes porous bed burning, compressible solids and gases, shock-induced decomposition with possible transition to detonation, and constant velocity ignition waves. Two-phase flow, gas relative to solid, is not allowed. Because the shock sensitivity of an explosive changes with explosive density and because such experimental data is rarely available over a range of densities, a method for the calculation of the density effect on the initial-shock-pressure, distance-to-detonation (wedge test) measure of shock sensitivity is given. The calculation uses the invariance with density of the shock particle velocity as a function of time to detonation, and the experimental data at some high density.
Pregnancy does not predispose to thermal injuries. Most burns are minor, and erythema usually subsides within 24 hours during the outpatient therapy. Severe burns during pregnancy are rare but alarming events. Care should be provided at a regional facility with expert burn care and fetal monitoring. Attempts should be undertaken during maternal transport to avoid hypovolemia, hypotension, and hypoxia. The wound should be covered with sterile dressings to prevent further contamination. Maternal and fetal survival is directly related to the extent of the body surface injury. When maternal injury is lethal, fetal survival is very unlikely because of sudden in-utero death or complications from prematurity following spontaneous labor. Complications to be considered during the emergent and acute phases of recovery include fluid and electrolyte imbalance, respiratory difficulties, systemic and wound infection, inadequate nutrition, and emotional disturbances. Therapy should be directed to saving the mother. Whether fetal well being is compromised by the burn and resultant therapy is difficult to determine from prior published reports. Periodic ultrasonic examination and biophysical testing of the fetus are recommended. If conditions are considered unfavorable to meet fetal circulatory and oxygen demands, prompt delivery during the late second and third trimesters has been advocated if the mother's burn covers 50 per cent or more of the surface area. If the patient has instead recovered satisfactorily and there has been no evidence of fetal jeopardy or premature labor within the first week following the burn injury, the eventual delivery of a healthy-appearing, term-sized fetus is quite likely. PMID:6352144
Smith, B K; Rayburn, W F; Feller, I
The development of effective, non-toxic (local and systemic) methods for the rapid chemical (enzymatic and non-enzymatic) debridement of third degree burns would dramatically reduce the morbidity and mortality of severely burned patients. Sepsis is still the major cause of death of patients with extensive deep burns. The removal of the devitalized tissue, without damage to unburned skin or skin only partially injured by burning, and in ways which would permit immediate (or very prompt) skin grafting, would lessen substantially the problems of sepsis, speed convalescence and the return of these individuals to society as effective human beings, and would decrease deaths. The usefulness and limitations of surgical excision for patients with extensive third degree burns are discussed. Chemical debridement lends itself to complementary use with surgical excision and has the potential advantage over surgical excision in not requiring anesthesia or a formal surgical operation. The authors' work with the chemical debridement of burns, in particular the use of Bromelain, indicates that this approach will likely achieve clinical usefulness. The experimental studies indicate that rapid controlled debridement, with minimal local and systemic toxicity, is possible, and that effective chemotherapeutic agents may be combined with the Bromelain without either interfering with the actions of the other. The authors believe that rapid (hours) debridement accomplished by the combined use of chemical debriding and chemotherapeutic agents will obviate the possibility of any increase in infection, caused by the use of chemical agents for debridement, as reported for Paraenzyme(21) and Travase.(39,48) It is possible that the short term use of systemic antibiotics begun just before and continued during, and for a short time after, the rapid chemical debridement may prove useful for the prevention of infection, as appears to be the case for abdominal operations of the clean-contaminated and contaminated types. PMID:4606330
Levenson, S M; Kan, D; Gruber, C; Crowley, L V; Lent, R; Watford, A; Seifter, E
A solid or semisolid propellant is described comprising grains of propellant or propellant components bonded together to create voids within the propellant volume. The grains are of near-uniform size and have less than about a 20% size variation between the largest and smallest grains, the voids comprising from about 10% to about 50% of the propellant volume. The grains are bonded together with sufficient strength to substantially delay the fluidization of the propellant by the onset of Taylor unstable burning. The propellant has a rapid burn rate of from about 10 cm sec/sup -1/ to about 10/sup 4/cm sec/sup -1/.
Colgate, S.A.; Roos, G.E.
Context: Chickenpox (varicella) is a common viral disease caused by Varicella zoster virus. Facial atrophic scars after varicella infection are not uncommon and pose a cosmetic problem. Like atrophic scars of other aetiologies, they are a difficult condition to treat. There are not enough references in the literature regarding efficient treatment of post varicella scars. High strength Trichloroacetic acid (TCA), which is known to cause dermal collagen remodelling, was used to treat varicella scars in the present study. Aims: The study was undertaken to assess the efficiency of Chemical Reconstruction of Skin Scars (CROSS) technique using 100% TCA in the treatment of atrophic facial post varicella scars. Settings and Design: Open label, pilot study. Materials and Methods: A total of 16 patients with atrophic facial post varicella scars were treated by focal application of 100% TCA solution by pressing down upon the scar surface by a toothpick (CROSS technique). Total 4 sittings were given at 2 weekly intervals and the results evaluated after 3 months of follow-up. Statistical analysis was carried out using Fischer's exact t-test. Results: All of the 13 patients who completed the study showed good clinical improvement, with 69% patients grading the response as excellent (>75%) improvement, whereas the rest 31% patients reporting good (51-75%) improvement. No significant complications were seen in any patient. Conclusions: CROSS technique using 100% TCA is a safe, cheap and effective therapy for the treatment of post varicella scars.
Agarwal, Nidheesh; Mittal, Asit; Kuldeep, CM; Gupta, Lalit Kumar; Khare, Ashok Kumar; Mehta, Sharad
We carried out a review of self-inflicted burns presenting to the National Burns Unit in the Republic of Ireland. 87 self-inflicted burns were identified over a 12-year period accounting for 4.2% of total Burns Unit admissions. Patient demographics were identified. The majority of patients had a history of mental illness and deliberate self harm. We also examined the motivation behind the self-immolation, the total body surface area involved and the mortality rates. PMID:21726948
Seoighe, D M; Conroy, F; Hennessy, G; Meagher, P; Eadie, P
The First Society for Computer Applications in Radiology (SCAR) Transforming the Radiological Interpretation Process (TRIP) Conference and Workshop, "Transforming Medical Imaging" was held on January 31-February 1, 2005 in Bethesda, MD. Representatives from all areas of medical and scientific imaging-academia, research, industry, and government agencies-joined together to discuss the future of medical imaging and potential new ways to manage the explosion in numbers, size, and complexity of images generated by today's continually advancing imaging technologies. The two-day conference included plenary, scientific poster, and breakout sessions covering six major research areas related to TRIP. These topic areas included human perception, image processing and computer-aided detection, data visualization, image set navigation and usability, databases and systems integration, and methodology evaluation and performance validation. The plenary presentations provided a general status review of each broad research field to use as a starting point for discussion in the breakout sessions, with emphasis on specific topics requiring further study. The goals for the breakout sessions were to define specific research questions in each topic area, to list the impediments to carrying out research in these fields, to suggest possible solutions and near- and distant-future directions for each general topic, and to report back to the general session. The scientific poster session provided another mechanism for presenting and discussing TRIP-related research. This report summarizes each plenary and breakout session, and describes the group recommendations as to the issues facing the field, major impediments to progress, and the outlook for radiology in the short and long term. The conference helped refine the definition of the SCAR TRIP Initiative and the problems facing radiology with respect to the dramatic growth in medical imaging data, and it underscored a present and future need for the support of interdisciplinary translational research in radiology bridging bench-to-bedside. SCAR will continue to fund research grants exploring TRIP solutions. In addition, the organization proposes providing an infrastructure to foster collaborative research partnerships between SCAR corporate and academic members in the form of a TRIP Imaging Informatics Network (TRIPI(2)N). PMID:16511675
Andriole, Katherine P; Morin, Richard L
Having examined the application of quasi-equilibrium to hydrostatic silicon burning in Paper I of this series, we now turn our attention to explosive silicon burning. Previous authors have shown that for material that is heated to high temperature by a passing shock and then cooled by adiabatic expansion, the results can be divided into three broad categories, incomplete burning, normal
W. Raphael Hix; Friedrich-Karl Thielemann
The application of vegetation indices is a very common approach in remote sensing of burned areas to either map the fire scar or estimate burn severity since they minimize the effect of exogenous factors and enhance the correlation with the internal parameters of vegetation. In a recent study we found that the original spectral channels, based on which these indices are estimated, are sensitive to external parameters of the vegetation as for example the spectral reflectance of the background soil. In such cases, the influence of the soil in the reflectance values is different in the various spectral regions depending on its type. These problems are further enhanced by the non-homogeneous pixels, as created from fractions of different types of land cover. Parnitha (Greece), where a wildfire occurred on July 2007, was established as test site. The purpose of this work is to explore the sensitivity of vegetation indices when used to estimate and map different fractions of fire-scorched (burned) and non fire-scorched (vegetated) areas. IKONOS, a very high resolution satellite imagery, was used to create a three-class thematic map to extract the percentages of vegetation, burned surfaces, and bare soil. Using an overlaid fishnet we extracted samples of completely "burned", completely "vegetated" pixels and proportions with different burn/vegetation ratios (45%-55% burned - 45%-55% vegetation, 20%-30% burned - 70%- 80% vegetation, 70%-80% burned - 20%-30% vegetation). Vegetation indices were calculated (NDVI, IPVI, SAVI) and their values were extracted to characterize the mentioned classes. The main findings of our recent research were that vegetation indices are less sensitive to external parameters of the vegetation by minimizing external effects. Thus, the semi-burned classes were spectrally more consistent to their different fractions of scorched and non-scorched vegetation, than the original spectral channels based on which these indices are estimated.
Pleniou, M.; Koutsias, N.
Burn patient survival has significantly increased during the past four decades as hypovolaemic shock, acute renal failure, invasive bacterial burn wound infection, Curling's ulcer, and metabolic wasting have been controlled by timely adequate resuscitatio...
B. A. Pruitt
Abdominal catastrophe in the severely burned patient without abdominal injury has been described. We perceived an alarming recent incidence of this complication in our burn center, both during acute resuscitation and later in the hospital course. We sough...
C. E. White E. M. Renz K. W. Markell L. H. Blackbourne M. E. Albrecht
The instrument measures accurately the burning rate of solid propellant rocket motors. This is accomplished by use of light-transmitting rods of different lengths embedded in a propellant grain and transmitting light energy during burning of the grain to ...
J. E. Fitzgerald N. C. Allen
We evaluated the laser induced burn wound healing efficacy of a recombinant low-molecular-weight protamine conjugated epidermal growth factor (rLMWP-EGF). rLMWP-EGF was prepared by genetically combining LMWP with the N-terminal sequence of EGF; we obtained a homogeneous modified EGF without reduced biological activity. Because of the protein transduction domain of LMWP, rLMWP-EGF showed enhanced drug penetration across artificial skin constructs and excised mouse skin layers versus EGF and showed significantly improved burn wound healing efficacy, with accelerated wound closure and minimized eschar and scar formation, compared with EGF or no treatment. Histological examination also revealed that rLMWP-EGF permeated through the intact skin around the wound and facilitated residual epithelial cell proliferation in an integrated manner to reform an intact epidermis. Radiofrequency microwound formation was effective for reducing large hypertrophic scars formed after severe laser burning by collagen remodeling but rLMWP-EGF did not show a meaningful synergistic effect in burn scar reduction. However, rLMWP-EGF was helpful for forming skin with a more normal appearance and texture. Thus, rLMWP-EGF demonstrated therapeutic potential as a novel topical burn wound healing drug with no obvious toxic effect. © 2013 Wiley Periodicals, Inc. and the American Pharmacists Association J Pharm Sci 102:4109-4120, 2013. PMID:24018779
Lee, Ji Hae; Bae, Il-Hong; Choi, Jin Kyu; Park, Jin Woo
To fix and make the nation's Superfund law work, two related questions must be answered. First, where will the innovative technology come from the clean up Superfund and other waste sites Burning dirt--the best technology currently available--is an expensive nonsolution. Second, can man muster the political will to make Superfund a waste cleanup law instead of an expanding welfare program
|Environmental educators are worried about the ultimate ecological threat--nuclear war, which could burn thousands of square miles, sterilize the soil, destroy 70 percent of the ozone layer letting in lethal ultraviolet rays, and cause severe radiation sickness. Educators must inform themselves, teach others, contact government representatives,…
A case of profuse bleeding during dilation and curettage due to Cesarean scar pregnancy was treated with emergency laparoscopy.\\u000a The gestational mass was removed and the perforated uterus was sutured in laparoscopy. The patient had persistent bleeding\\u000a and 4 months later laparotomy was performed to explore a cystic mass in the isthmic area of the uterus. This necrotic tissue\\u000a was
Markku Santala; Jatta Pirkola; Maarit Niinimäki
Hypertrophic and keloid scars still are among the banes of plastic surgery. In the treatment arsenal at the disposal of the\\u000a plastic surgeon, topical silicone therapy usually is considered the first line of treatment or as an adjuvant to other treatment\\u000a methods. Yet, knowledge concerning its mechanisms of action, clinical efficacy, and possible adverse effects is rather obscure\\u000a and sometimes
Demetris StavrouOren; Oren Weissman; Eyal Winkler; Lior Yankelson; Eran Millet; Oren Paul Mushin; Alon Liran; Joseph Haik
A new disease, the slippery scar, was investigated in cultivated bags of Auricularia polytricha. This fungus was isolated from the infected mycelia of cultivated bags. Based on morphological observation, rDNA-internal transcribed spacer and 18S sequence analysis, this pathogen was identified as the Ascomycete Scytalidium lignicola. According to Koch's Postulation, the pathogenicity of S. lignicola to the mycelia of A. polytricha was confirmed. The parasitism of this fungus on mushroom mycelia in China has not been reported before.
A new disease, the slippery scar, was investigated in cultivated bags of Auricularia polytricha. This fungus was isolated from the infected mycelia of cultivated bags. Based on morphological observation, rDNA-internal transcribed spacer and 18S sequence analysis, this pathogen was identified as the Ascomycete Scytalidium lignicola. According to Koch's Postulation, the pathogenicity of S. lignicola to the mycelia of A. polytricha was confirmed. The parasitism of this fungus on mushroom mycelia in China has not been reported before. PMID:22870056
Sun, Jie; Bian, Yinbing
Conclusions It is now time to consider what conclusions are possible from the foregoing discussion. My purpose in writing this paper has\\u000a been to draw attention to the distinction between portal cirrhosis and post-necrotic scarring, because I believe that these\\u000a conditions are distinct and that it is of value to separate them where possible. The view has been adopted that the
The effects of removal and readmission of substrates on the K contracture were investigated in the guinea-pig taenia coli. When, after exposure to excess K in Ca-free and glucose-free medium, the readmission and removal of 2.4 mM-Ca were repeated at regular intervals, the Ca-induced contractions decreased progressively. The decrease was more marked in the late than in the early part of the tension response. The rate of O2 consumption decreased when the normal medium was replaced by glucose-free, Ca-free, excess-K solution, but substantially recovered following Ca readmission. ATP and creatine phosphate contents decreased during the Ca-induced contraction, but recovered partially during the subsequent relaxation in Ca-free solution. The effects of glucose removal were rapidly reversed when glucose or beta-hydroxybutyrate (beta-HB) were readmitted to the bathing solution. In the absence of Ca, readmission and removal of the substrates produced an insignificant change in O2 consumption, but the next Ca contraction was potentiated, the effect being stronger with glucose than beta-HB. When the tonic contraction evoked by 2.4 mM-Ca readmission had been abolished in glucose-free, high-K solution, a rise of the external Ca concentration to 10 mM, or 5 microM-carbachol, still produced a transient contraction. This suggests that the tonic contraction has disappeared partially because of diminished Ca influx. In glycogen-depleted preparations, the depolarization caused by carbachol, or by 20 mM-K, was in