Background: The combination of surgery and postoperative radiotherapy allows for the most effective results with keloids. In this trial, surgery and intraoperative radiation therapy (IORT) technology were used—the hypothesis being that the earlier the application of postoperative radiotherapy, the better the wound healing evolution. Methods: The study included 16 patients with 21 keloids. The keloids were radically excised and repaired with direct suture or local skin flaps. Collimated electron radiotherapy was applied within 45 minutes of surgery. The outcomes were assessed according to the modified Patient and Observer Scar Assessment Scale; the modified Vancouver Scar Scale; and the modified Common Terminology Criteria for Adverse Events v. 4.0 for skin and subcutaneous tissue disorders. Results: Recurrences were observed in one out of 16 patients, and in two out of 21 keloids (9.5%). The modified Patient and Observer Scar Assessment Scale demonstrated a statistically significant improvement in pain, itching, color, stiffness, thickness, and irregularity after the treatment. The modified Patient and Observer Scar Assessment Scale displayed a statistically significant improvement in the scar vascularity, pigmentation, thickness, and pliability after the treatment. The modified Vancouver Scar Scale demonstrated a statistically significant improvement in 90.48% of the scars after the treatment. The modified Common Terminology Criteria for Adverse Events v. 4.0 for skin and subcutaneous tissue disorders demonstrated an improvement in erythema multiforme and skin pain across the whole sample, with a temporary hyperpigmentation in 19% of the scars after the treatment. Conclusion: The combination of surgery and collimated electron radiotherapy with IORT technology demonstrated favorable results in 90.5% of the cases.
Objective: The purpose of this study was the introduction in clinical practice of the combined application of traditional reconstructive surgery and intense pulsed light (IPL) for the restoration of a post-traumatic eyebrow defect. Case: The authors present a case of surgical eyebrow reconstruction with an axial temporal hair-bearing scalp island flap. A persistent localized erythema and a marked difference in hair density in comparison with the contralateral one harmed the eventual surgical outcome. Results: A combined sequential treatment with IPL achieved both hair density and skin erythema reduction, and eventually allowed for a very satisfactory result. Conclusions: Our experience demonstrated the efficacy of the integrated multidisciplinary approach involving traditional plastic reconstructive surgery and the innovative new technologies in aiming for perfection.
Planning is the key for success in plastic surgery, and accurate and meticulous tissue marking is a key step in pre-or intraoperative planning. Preoperative skin marking actually is an exceptionally effective exercise for the young trainee to try her or his hand at proposing and planning a surgical procedure. Such a preliminary step is also of great help in obtaining fully informed consent from the patient, who can be shown the actual nature and extent of the procedure and the position and length of the eventual scars. A huge variety of dermographic pens, pencils, pen nibs, and dyes are currently available for such a purpose. All of these tools have to be sterilizable for intraoperative use, and vital dyes only should be used to avoid any permanent skin tattoo. Furthermore, the stroke has to be long-lasting and should not be faded by antiseptic solutions and organic fluids. Nevertheless, an excessively long-lasting stroke may sometimes be a problem in the preoperative phase of surgical planning when multiple and different options have to be critically assessed, considering their pros and cons. Everyday life tools have been gaining an increasing popularity for ingenious "off-label" use in medicine and surgery. In our practice, we have been favoring a common makeup pencil for skin marking during our preliminary clinical consultations when the most appropriate surgical strategy is discussed and tailored to each individual patient. A makeup pencil stroke is easy to erase and can be completely removed by a gentle wiping with cleansing milk (►Figs. 1A, 1B). In our opinion, such a simple pencil proves to be an invaluable tool for the hands-on training in plastic surgery, allowing the young trainee to try her or his hand at the preoperative simulation of different Figure 1 In-office consultation of a patient with two basal cell carcinomas of the right cheek and glabella. (A) The proposed surgical plan is marked with a fiber-tip marker in the right cheek and with a makeup pencil in the glabella. (B) Marking is removed with an appropriate dermocompatible solvent and cleansing milk, respectively. A sketch "phantom" is still appreciated in the right cheek while the markings in the glabella have been easily and completely removed. Issue Theme Revision Rhinoplasty;
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