Scar Management in the Pediatric and Adolescent Populations

Krakowski, Andrew C.; Totri, Christine R.; Donelan, Matthias B.; Shumaker, Peter R.

doi:10.1542/peds.2014-2065

Cited by 44 publications

(47 citation statements)

References 131 publications

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“…Scar location and a patient's perspective of the scar have been shown to be more important in psychosocial outcomes than simply a scar's physical characteristics. 28 , 29 Hiding incisions in the axilla ( Figure 5 ) or behind the ear, by using transaxillary and retroauricular approaches, respectively, may decrease the psychosocial impact that can result from visible scars in the pediatric population. All patients in our study were satisfied with the cosmetic appearance of the neck during follow-up.…”

Section: Discussionmentioning

confidence: 99%

Robotic Neck Surgery in the Pediatric Population

Garstka

Kang

et al. 2018

JSLS

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Introduction:Thyroid, parathyroid, and thymus surgeries are traditionally performed via a cervical approach. However, robot-assisted procedures can provide a safe alternative for neck surgeries. We report our experiences with robotic transaxillary and retroauricular approaches in pediatric patients.Case Presentation:We conducted a retrospective review of pediatric patients who underwent robot-assisted neck surgery by a single surgeon between April 2010 and May 2017. Patient demographics and surgical outcomes including operative time, incidence of complications, and length of hospital stay were evaluated.Management and Outcomes:Nine surgeries in 7 female patients were reviewed (mean age, 16.0 ± 1.58 years; mean body mass index, 22.5 ± 0.75). Two thyroid lobectomies, 2 complete thyroidectomies, 1 subtotal thyroidectomy, 1 thyroid lobectomy with thymectomy, 2 subtotal parathyroidectomies with thymectomy, and 1 dermoid cyst excision were performed. Two surgeries with the retroauricular approach had a mean surgical time of 142.0 ± 6.13 minutes. Seven surgeries with the transaxillary approach had a mean surgical time of 146.1 ± 21.01 minutes. There were no reported conversions, permanent vocal cord paralysis, permanent hypoparathyroidism, hematoma, or seroma. There was 1 case (11%) of temporary shoulder hypoesthesia and 2 cases of temporary vocal cord paresis (22%).Discussion:This series on robot-assisted neck surgeries in children describes procedures performed with robotic transaxillary and retroauricular approaches. In the hands of a high-volume surgeon the techniques are feasible and safe options for operations in the neck in a select group of pediatric patients.

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Section: Discussionmentioning

confidence: 99%

Robotic Neck Surgery in the Pediatric Population

Garstka

Kang

et al. 2018

JSLS

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“…Dermatofibroma, keloid, and scar are common dermal tumors that may be tender. Digital fibromyxoma (superficial acral fibromyxoma) is an uncommonly described, yet distinctive tumor of the hands and feet – usually the distal digits – which often presents as a painful mass 1,2,11–13…”

Section: Discussionmentioning

confidence: 99%

“…It results from an overgrowth of collagen and is frequently found on the earlobes, chest, posterior neck, proximal extensor arms, shoulders, and upper back. Microscopically, it is characterized by thick bundles of collagen (“bundles of rope”) that are randomly organized to the overlying epidermis 12,13…”

Section: Discussionmentioning

confidence: 99%

<p>Painful tumors of the skin: “CALM HOG FLED PEN AND GETS BACK”</p>

Cohen¹,

Erickson

Calame

2019

CCID

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Painful tumors of the skin present as dermal or subcutaneous nodules. They can originate from several sources: adipose tissue, cartilage degeneration, deposition of bone or calcium, eccrine glands, fibrous tissue, infiltration of benign (endometrium) or malignant (metastatic neoplasm) tissue, muscle, nerve, or vascular structures. Although pathologic evaluation of the lesion is necessary to determine the diagnosis, it is possible to make a reasonable differential diagnosis based on knowledge of prior tumors that have appeared as tender lesions. Two women with painful skin tumors – either osteoma cutis or an organizing thrombus – are described. Based on our clinical experience and review of the literature, 25 painful skin tumors were identified: c hondrodermatitis nodularis helicis, a ngioendotheliomatosis, l eiomyoma, m etastases, h idradenoma, o steoma cutis, g lomus tumor, f ibromyxoma, l eiomyosarcoma, e ccrine angiomatous hamartoma, D ercum’s disease, p eizogenic pedal papule, n eurilemmoma, a ngiolipoma, n euroma, d ermatofibroma, g ranular cell tumor, e ndometriosis, t hrombus, s car, b lue rubber bleb nevus, a ngioma, c alcinosis cutis, and k eloid. An acronym – inspired by Charlotte’s Web, a book that many children have read – that can be used as a memory aid for recalling the list of painful skin tumors is introduced: “CALM HOG FLED PEN AND GETS BACK”.

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“…The local factors that promote pathological scar development are, like the genetic factors, well-studied and include the elastic tension on the skin and mechanical stress (Aoki et al, 2020). Much less well-understood are the systemic factors that associate with keloidogenesis; these include adolescence, pregnancy (Park and Chang, 2012;Krakowski et al, 2016), and endothelial dysfunction. With regard to the latter factor, mounting evidence now suggests that disturbed endothelial function may in fact play a key role in initiating and augmenting the pathogenic activities of other important cellular players in pathological scarring.…”

Section: Discussionmentioning

confidence: 99%

Gene Expression Profile of Isolated Dermal Vascular Endothelial Cells in Keloids

Matsumoto

Aoki

Okubo

et al. 2020

Front. Cell Dev. Biol.

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Wound healing is a complex biological process, and imbalances of various substances in the wound environment may prolong healing and lead to excessive scarring. Keloid is abnormal proliferation of scar tissue beyond the original wound margins with excessive deposition of extracellular matrix (ECM) and chronic inflammation. Despite numerous previous research efforts, the pathogenesis of keloid remains unknown. Vascular endothelial cells (VECs) are a major type of inductive cell in inflammation and fibrosis. Despite several studies on vascular morphology in keloid formation, there has been no functional analysis of the role of VECs. In the present study, we isolated living VECs from keloid tissues and investigated gene expression patterns using microarray analysis. We obtained 5 keloid tissue samples and 6 normal skin samples from patients without keloid. Immediately after excision, tissue samples were gently minced and living cells were isolated. Magnetic-activated cell sorting of VECs was performed by negative selection of fibroblasts and CD45 + cells and by positive selection of CD31 + cells. After RNA extraction, gene expression analysis was performed to compare VECs isolated from keloid tissue (KVECs) with VECs from normal skin (NVECs). After cell isolation, the percentage of CD31 + cells as measured by flow cytometry ranged from 81.8%-98.6%. Principal component analysis was used to identify distinct molecular phenotypes in KVECs versus NVECs and these were divided into two subgroups. In total, 15 genes were upregulated, and 3 genes were downregulated in KVECs compared with NVECs using the t-test (< 0.05). Quantitative RT-PCR and immunohistochemistry showed 16fold and 11-fold overexpression of SERPINA3 and LAMC2, respectively. SERPINA3 encodes the serine protease inhibitor, α1-antichymotripsin. Laminin γ2-Chain (LAMC2) is a subunit of laminin-5 that induces retraction of vascular endothelial cells and enhances vascular permeability. This is the first report of VEC isolation and gene expression analysis in keloid tissue. Our data suggest that SERPINA3 and LAMC2 upregulation in KVECs may contribute to the development of fibrosis and prolonged inflammation in keloid. Further functional investigation of these genes will help clarify the mechanisms of abnormal scar tissue proliferation.

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Scar Management in the Pediatric and Adolescent Populations

Cited by 44 publications

References 131 publications

Robotic Neck Surgery in the Pediatric Population

Robotic Neck Surgery in the Pediatric Population

<p>Painful tumors of the skin: “CALM HOG FLED PEN AND GETS BACK”</p>

Gene Expression Profile of Isolated Dermal Vascular Endothelial Cells in Keloids

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Scar Management in the Pediatric and Adolescent Populations

Cited by 44 publications

References 131 publications

Robotic Neck Surgery in the Pediatric Population

Robotic Neck Surgery in the Pediatric Population

<p>Painful tumors of the skin: &ldquo;CALM HOG FLED PEN AND GETS BACK&rdquo;</p>

Gene Expression Profile of Isolated Dermal Vascular Endothelial Cells in Keloids

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<p>Painful tumors of the skin: “CALM HOG FLED PEN AND GETS BACK”</p>