Scar Symptoms: Pruritus and Pain

Min

et al. 2023

Preprint

Background Surgical debridement is usually an essential step in treating complex facial lacerations (CFL). As the severity of CFL increases, conventional surgical debridement (CSD) of wound edges becomes difficult and may be insufficient to remove damaged tissues and create clean edges. Because the severity and shape of CFL are diverse and different, it is necessary to tailor the customized pre-excisional design, the tailored surgical debridement (TSD), for each case before performing surgical debridement. Applying TSD is expected to enable effective debridement in CFL with higher severity. This study compared cosmetic outcomes and complication incidence of CSD and TSD, according to CFL severity. Methods This was a retrospective observational study. Eligible patients with CFL who visited the emergency department between August 2020 and December 2021 were examined. CFL severity was graded to Grades I and II. CSD and TSD outcomes were compared using the Scar Cosmesis Assessment and Rating (SCAR) scale. Furthermore, a good cosmetic outcome was defined as a SCAR score of ≤ 2. The percentage of good cosmetic outcome between the two groups was compared. The SCAR score and percentage of good cosmetic outcomes between the two groups were compared overall and by severity. For comparison of complication incidence, asymmetry, infection, and dehiscence incidence were compared. Results In total, 252 patients were enrolled (121 [48.0%] CSD and 131 [52.0%] TSD). In CSD and TSD groups, the median SCAR scores were 3 (1–5) and 1 (0–2) in all enrolled patients (p < 0.001), 2 (0–4) and 1 (0–1) in Grade I (p < 0.01), and 5 (4–6) and 1 (1–2) in Grade II (p < 0.001). The good cosmetic outcomes were 46.3% and 84.0% overall (p < 0.001), 59.6% and 85.0% in Grade I (p < 0.01), and 9.4% and 83.5% in Grade II (p < 0.001) for CSD and TSD. The incidence of complications was significantly higher in the CSD than in the TSD groups, but this was limited to asymmetry. There was no statistical difference in both infection and dehiscence. Conclusion TSD can lead to an objectively good cosmetic prognosis at higher CFL severity than CSD and can reduce the occurrence of facial asymmetry.

Section: Discussionmentioning

confidence: 99%

Tailored versus conventional surgical debridement in complex facial lacerations: a retrospective study

Min

et al. 2023

Preprint

“…The time elapsed since surgery ranged from 2 months to 3 years. Pain or itching when wearing a mask may be due to scar tissue or inflammation in the surgical region [ 16 ]; however, patients who felt symptoms when not wearing a mask did not hear. In addition, no patients complained of pain on the contralateral side compared to the surgical site due to numbness caused by temporary damage of the sensory nerve around the incision site [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Is the retroauricular region a suitable donor site for full-thickness skin grafting in the era of mask wearing?

Kim¹,

Park²,

et al. 2023

Arch Craniofac Surg

Background: During the coronavirus disease 2019 (COVID-19) pandemic, the everyday use of face masks massively increased to prevent the spread of infection. Many people complain of ear pain and erosion when wearing a mask for extended periods of time. If prolonged mask usage is uncomfortable for ordinary people, a question arises—how much more inconvenient must mask wearing be for patients with a full-thickness skin graft (FTSG) donor site in the retroauricular region? Herein, we evaluated complications related to face mask use in 27 patients with a retroauricular FTSG donor site, with the goal of clarifying whether the retroauricular region is still an appropriate FTSG donor site in the context of the COVID-19 pandemic.Methods: Complications in 27 patients treated by FTSGs harvested from the retroauricular region from 2019 to 2021 were investigated. A questionnaire comparing the normal and the operated sides was administered. Pain, itching, soreness, deformity, and symmetry were further investigated.Results: Pain and itching were the only observed complications. The operated side was slightly more painful than the normal side in four patients (14.8%), and four patients (14.8%) reported itching on the operated side. However, all patients who experienced complications stated that the pain or itching did not interfere with mask wearing. Most symptomatic patients were older than 60 years of age (23.8%, <i>p</i>=0.185) and wore masks for longer periods of time (28.5%, <i>p</i>=0.326).Conclusion: Few retroauricular donor site-related complications occurred, and none of these complications caused inconvenience in daily life. Therefore, in the COVID-19 pandemic, the use of the retroauricular region as an FTSG donor site remains appropriate.

“…On the one hand, this may be due to the small size of the scar growths of the patients in this study and the fact that the patients themselves had fewer risk factors for manifesting pruritus. 19 On the other hand, it may be related to the fact that laser treatment reduces the pruritus symptoms of the patients, 20 so that no significant pruritus manifested itself in either group. Both treatment modalities not only have a synergistic effect by reducing the thickness as well as the tenderness of the scar, but also have their own unique effects, such as the laser reducing the patients’ pruritus symptoms and the tension reducer reducing the width of the postoperative scar growth.…”

Section: Discussionmentioning

confidence: 99%

Clinical Observation of Sequential Laser Therapy Combined with Tension Reducer for Postoperative Tension Incision Scar Growth

Xie¹

2023

CCID

Objective To investigate the clinical effectiveness of laser and secure wound-closure system (Tension reducer) in the treatment of postoperative scarring after tension incision. Methods A retrospectively observational study was conducted. Twenty-six patients who underwent surgical treatment in our department between June 2017 and December 2021 were selected, and those treated with laser and tension reducer were treated as a combined treatment group, and those treated with laser were treated as a conventional treatment group. Fifteen patients in the conventional group were treated with the pulsed dye laser and CO 2 fractional laser at 1–2 month intervals. Eleven people in the combined treatment group were treated with the laser in addition to a tension reducer for 3–6 months. The scar width, scar thickness, scar hardness, pruritus score, modified Vancouver scar scale and complication rates between the two treatment modalities were compared between the two groups at 6 months postoperatively. Results The scar thickness, scar hardness and modified Vancouver scar scale of 1.25 (0.14, 1.90) mm, 31.80 (21.00, 37.20) HA, (6.00 ± 2.17) in patients in the combined treatment group were less than those of patients in the conventional treatment group of 5.50 (4.00, 11.50) mm, 42.60 (32.50, 47.00) HA, (8.25±1.91), (Z=2.883, 2.718, t=2.904, p<0.05). The scar width and pruritus score in the combined treatment group, were 8.00 (5.00, 18.00) mm and 0 (0, 1) respectively, while the scar score and pruritus score in the conventional treatment group, were 5.50 (4.00, 11.50) mm respectively, with no statistically significant difference between the two groups. The complication rate was 55% in the combined treatment group and no adverse reactions occurred in the control group. Conclusion Sequential laser combined with tension reducer treatment can effectively inhibit the proliferation of postoperative tension incision scar.