The Journal of craniofacial surgery
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Scars on exposed areas are a major concern among Asian populations because of their conspicuousness. Size, color, or whether the scar is hypopigmented or hyperpigmented matters little. Silicone gel is well known for the prevention and induction of better maturation of hypertrophic and keloid scars. However, its aesthetic effect on normal surgical scars has not been considered. ⋯ The silicone gel sheet has a favorable aesthetical effect for normally created surgical scars in the Asians. Its application can reduce the conspicuousness of scars more rapidly than without.
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The evaluation of microsurgical technique is often done in an attempt to enhance the skills of surgeons. However, it varies depending on the institution or supervisors. According to some of the research done so far, there are many institutes that enable surgeons to train themselves with enough time but are confronted with some other limiting factors. We have added the time factor and conducted our study on the evaluation of microsurgical techniques. The purpose of this study was to decide whether using a nonvital pig leg saves microsurgical training time and improves microsurgical skill and how effective this method is in an objective assessment. ⋯ The authors carried out microsurgical training using a protocol that added the time factor to the conventional evaluation studies. Microsurgical practice with pig legs statistically saves time and improves the skill in 3 full procedures including 5 practice end-to-end arterial anastomoses. This is an effective and economic method of developing the basic techniques performed during anastomosis procedures.
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In this prospective study, we used the Patient and Observer Scar Assessment Scale (POSAS) to evaluate the outcome of the healing process of posttraumatic and surgical facial scars that were treated with self-drying silicone gel, by both the patient and the observer. In our division, the application of base cream and massage represents the standard management of facial scars after suture removal. In the current study, 15 patients (7 men and 8 women) with facial scars were treated with self-drying silicone gel that was applied without massage, and 15 patients (8 men and 7 women) were treated with base cream and massage. ⋯ The OS primarily reported an improvement in the items vascularization, pigmentation, and pliability. The only item in the OS that underwent no change from T0 to T1 was surface area. The POSAS revealed satisfactory healing of posttraumatic and surgical facial scars that were treated with self-drying silicone gel.
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Scar color evaluation by clinical physicians has been based on subjective judgments. The purpose of this study was to investigate the application of a novel photographic analysis to produce an objective and quantitative measurement of scar color using the L*a*b* color coordinates. Three plastic surgeons evaluated photos of 207 scars using the clinical scar assessment scale developed by Beausang et al. ⋯ The correlation coefficients for interrater reliability and test-retest consistency were satisfactory. Objective scar evaluation using the L*a*b* color coordinates is found to be a reliable method to quantify scar color. With further study, this method could be simple and effective to assess the effects of scar management.
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Case Reports
Chiari type 1 malformation in an infant with type 2 Pfeiffer syndrome: further evidence of acquired pathogenesis.
There seems to be an association between type 1 Chiari malformation (CM) and some congenital craniosynostosis syndromes. Type 2 Pfeiffer syndrome is a condition associated with premature fusion of multiple cranial sutures, cloverleaf skull (kleeblatschädel deformity), prominent ptosis, thumb and first toe abnormalities, variable syndactyly, and mutated genes for type 1 or 2 fibroblast growth factor receptor. These children generally do poorly because of significant often severe neurologic and cognitive defects, and many die very young. ⋯ Posterior fossa decompression yielded a good result. This patient provides further evidence to support the concept of acquired tonsillar herniation in patients with craniosynostosis syndromes. The etiology seems multifactorial and related to (1) the disproportionately slow growth of the skull relative to the brain, particularly in the posterior fossa, secondary to early fusion of skull sutures, in turn secondary to congenital deficiencies in fibroblast growth factor receptors; (2) impaired venous sinus drainage; (3) hydrocephalus; and (4) resultant elevations in intracranial pressure.