Overview of Surgical Scar Prevention and Management

Management of incisional scar is intimately connected to stages of wound healing. The management of an elective surgery patient begins with a thorough informed consent process in which the patient is made aware of personal and clinical circumstances that cannot be modified, such as age, ethnicity, and previous history of hypertrophic scars. In scar prevention, the single most important modifiable factor is wound tension during the proliferative and remodeling phases, and this is determined by the choice of incision design. Traditional incisions most often follow relaxed skin tension lines, but no such lines exist in high surface tension areas. If such incisions are unavoidable, the patient must be informed of this ahead of time. The management of a surgical incision does not end when the sutures are removed. Surgical scar care should be continued for one year. Patient participation is paramount in obtaining the optimal outcome. Postoperative visits should screen for signs of scar hypertrophy and has a dual purpose of continued patient education and reinforcement of proper care. Early intervention is a key to control hyperplastic response. Hypertrophic scars that do not improve by 6 months are keloids and should be managed aggressively with intralesional steroid injections and alternate modalities.

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The evaluation of the nasal morphologic changes after bimaxillary surgery in skeletal class III maloccusion by using the superimposition of cone-beam computed tomography (CBCT) volumes

BackgroundThe purpose of this study was to evaluate nasal morphologic and maxillary skeletal changes occurring after bimaxillary surgery in skeletal class III patients, using a new method entailing superimposition of cone-beam computed tomography (CBCT) volumes.Materials & methodsThe subjects consisted of 30 adults (15 males and 15 females) who had presented with skeletal class III deformities. The subjects underwent Le Fort I advancement and impaction osteotomy and mandibular setback surgery. For closure of the maxillary vestibular incision, alar cinch suture and V-Y closure were performed. The pre- and post-operative CBCT data were superimposed and evaluated by voxel-by-voxel registration.ResultsAfter surgery, the nasolabial angle, nasal tip angle, nasal tip inclination and columellar angle showed significant increases (P < 0.01). The nasal tip protrusion and nasal height, meanwhile, had significantly decreased (P < 0.01), and the alar base width had increased (P < 0.01). The columellar length and nostril axis angle also had decreased, but the nostril area did not show any significant change.ConclusionsAfter surgery, as the maxilla had been moved upward and forward, the nasal tip was shifted antero-superiorly and the alar base width and nostrils were widened. CBCT superimposition, enabling 3D assessment of nasal morphologic changes, can be an effective tool for simultaneous measurement of skeletal and soft-tissue changes.     

Surgical Outcomes and Complications after Occipito-Cervical Fusion Using the Screw-Rod System in Craniocervical Instability

Objective

Although there is no consensus on the ideal treatment of the craniocervical instability, biomechanical stabilization and bone fusion can be induced through occipito-cervical fusion (OCF). The authors conducted this study to evaluate efficacy of OCF, as well as to explore methods in reducing complications.

Methods

A total of 16 cases with craniocervical instability underwent OCF since the year 2002. The mean age of the patients was 51.5 years with a mean follow-up period of 34.9 months. The subjects were compared using lateral X-ray taken before the operation, after the operation, and during last follow-up. The Nurick score was used to assess neurological function pre and postoperatively.

Results

All patients showed improvements in myelopathic symptoms after the operation. The mean preoperative Nurick score was 3.1. At the end of follow-up after surgery, the mean Nurick score was 2.0. After surgery, most patients'' posterior occipito-cervical angle entered the normal range as the pre operation angle decresed from 121 to 114 degree. There were three cases with complications, such as, vertebral artery injury, occipital screw failure and wound infection. In two cases with cerebral palsy, occipital screw failures occurred. But, reoperation was performed in one case.

Conclusion

OCF is an effective method in treating craniocervical instability. However, the complication rate can be quite high when performing OCF in patients with cerebral palsy, rheumatoid arthritis. Much precaution should be taken when performing this procedure on high risk patients.     

Comparing two types of augmentative and alternative communication systems for children with autism

This study compared acquisition and preference for two types of augmentative and alternative communication (AAC) systems in three pre-schoolers with autism. Acquisition of requesting behaviour using a picture-exchange system vs a voice-output communication aide (VOCA) was compared in an alternating treatments design. Following acquisition, both ACC systems were simultaneously available and the child could select which one of the two systems to use. There was little difference between picture-exchange and VOCA in terms of acquisition rates. Two children demonstrated a consistent preference for picture-exchange and the third showed a preference for the VOCA. Both speed of acquisition and system preference should be considered when designing AAC interventions for children with autism and related developmental disabilities.

Comparamos la adquisición y preferencia en relación a dos tipos de sistemas (AAC) de comunicación alternativa y aumentativa en 3 preescolares con autismo. Se comparó la adquisición de un comportamiento solicitado a través del uso de un sistema de intercambio de dibujos contra una ayuda de comunicación de producción de voz (VOCA), en un diseño de tratamiento alternativo. Después de la adquisición ambos sistemas AAC estuvieron disponibles en forma simultánea, y el niño podía seleccionar cuál de los dos sistemas usar. Hubo poca diferencia entre el intercambio de dibujos y VOCA en término de tasas de adquisición. Dos niños demostraron una preferencia consistente para el intercambio de dibujos y el tercero demostró una preferencia por la VOCA. Tanto la velocidad de adquisición como la preferencia por un sistema deberán ser consideradas cuando se diseñen intervenciones con AAC para niños con autismo y discapacidades en el desarrollo relacionadas.

Palabras Clave: comunicación alternativa y aumentativa, intercambio de dibujos, ayudas de comunicación de producción de la voz, adquisición, autismo.     

A case report of an intracaval extrathoracic solitary fibrous tumour

Solitary fibrous tumours are infrequent neoplasms based in the pleura that are predominantly benign with malignant pathology and behaviour described in 10–36% of cases. Extrathoracic solitary fibrous tumours (ESFTs) have been considered separately to their intrathoracic counterparts and comprise a third of all solitary fibrous tumours. The extrathoracic location was identified as an adverse prognostic factor for local recurrence but not for metastatic disease. So far, there have not been any reports of solitary fibrous tumours demonstrating caval infiltration. We present a case of a benign ESFT infiltrating into the perirenal inferior vena cava. Together with extrauterine leiomyomas, ESFTs should also be considered as a differential diagnosis for the rare benign lesions invading the inferior vena cava.     

Unprecedented surface stabilized InP quantum dots with bidentate ligands

For InP-based QDs, the current technology does not outperform CdSe-based QDs in many respects, one of which is stability. The optical stability of QDs is closely related to their surface properties, so QDs often use organic ligands for surface protection. These organic ligands are dynamically attached and detached on the QD surface; during detachment, their surfaces are easily damaged and oxidized, thereby deteriorating their optical characteristics. Therefore, we have synthesized a ligand 1,2-hexadecanedithiol with a bidentate form, inducing one ligand to bind to the QD surface strongly through the chelate effect, as a good way to improve the stability of the QDs; thus, the PL stability of the green-light-emitting InP-based QDs was greatly increased. To confirm the existence of the dithiol ligand, we used thermogravimetric analysis/simultaneous thermal analysis-mass spectroscopy (TGA/STA-MS). After that, we applied the ligand to blue-light-emitting ZnSe QDs and red-light-emitting InP QDs, and for those two types of QD we also confirmed that the stability was increased. Additionally, we tested dithiol exchanged QDs at a high temperature of 150 °C, and the increase of stability was effective even in a high temperature condition.

For InP-based QDs, the current technology does not outperform CdSe-based QDs in many respects, one of which is stability.