Natural Medicine for Scars Found

The Scar Solution Ebook

The Scar Solution, an e-book authored by Sean Lowry, provides effective, yet natural and affordable, solutions to lessen the appearance of scars. Sean Lowry is not just your average author of an e-book. She can empathize with her readers because she also once suffered from the shame of scars on both the physical and psychological levels. Sean tried out a number of scar treatment techniques on herself and finally figured out a solution which made her completely scar free. With a view to help and for the benefit of others who may be anguished or embarrassed of scars (on any part of their body) she has shared her unique scar removal method in Scar Solution ebook. This is not a magic solution which will start working as soon as users buy the book. Unless the techniques and methods prescribed for scar elimination are followed for the time period mentioned therein the results will not be positive. Users must be committed to follow the scar treatment solution provided in this program with patience and dedication. Continue reading...

The Scar Solution Natural Scar Removal Summary


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Highly Recommended

Of all books related to the topic, I love reading this e-book because of its well-planned flow of content. Even a beginner like me can easily gain huge amount of knowledge in a short period.

Overall my first impression of this book is good. I think it was sincerely written and looks to be very helpful.

Short Scar Periareolar Inferior Pedicle Reduction Spair Mammaplasty

Breast Reduction Scar

Reast reduction offers an opportunity rarely seen in plastic surgery, for not only is there too much volume, there is too much skin. With a sound operative strategy, excellent technique, and a discerning artistic eye, the sculpting of an artistic and stable breast shape can occur every time, and now we can do it with half the scar What an exciting time to be a plastic surgeon. pattern technique have been thrown into sharper focus. Specifically, the inframammary scar can be problematic in some patients, with the medial and lateral portions of the scar being prone to hypertrophy. Additionally, the postoperative shape change associated with the Wise pattern technique can occasionally spill over from simple postoperative settling into a shape distortion known as bottoming out. Taken together, these two complications can adversely affect the overall result after breast reduction. Recent advances in breast reduction technique have attempted to address these problems by reducing the amount...

Vertical Scar Mammaplasty with a Superior Pedicle

Extreme Breast Growth Teens

In training who performed the operation in the university hospital. The same unfavorable results were published by Pickford 15 . Therefore, we tried to make the technique safer, keeping in mind the basic principles of the vertical scar mammaplasty. The goal of breast reduction is the correction of the volume, shape, and symmetry of the breast while preserving nipple sensitivity. Since the early days of breast surgery, many surgical techniques have been proposed to reach this goal, but over the two last decades, new techniques have been published that attempt to minimize the scars. The periareolar scar is unavoidable as the nipple-areola complex has to be repositioned, but the vertical scar has proved to be avoidable in mastopexies 6 , as has the horizontal submammary scar in the majority of cases, even in large reductions 3 . Following the description of Dar-tigues in 1925 and the publication of Lassus in 1970 8 , in the early 1990s Lejour popularized a technique derived from Lassus 9...

Breast Reduction Scars

Breast Reduction Scars

Enlargement of the vertical and or areolar scar is present in 5 of patients. We believe this is due to technical reasons, either because of improper closure or because of inadequate compensation for the excess skin around the areola. The solution is simple revi Fig. 11.17. a-c Preoperative view of a young patient with hypertrophy and ptosis. d-f Postoperative view 17 months later. g Arms are elevated to allow visualization of the vertical scar, not extending beyond the submammary fold Fig. 11.17. a-c Preoperative view of a young patient with hypertrophy and ptosis. d-f Postoperative view 17 months later. g Arms are elevated to allow visualization of the vertical scar, not extending beyond the submammary fold sion of the scars with new anchoring of the skin and immobilization. If scar hypertrophy or keloid occurs, radiation therapy is advised. No revision should be undertaken until at least 6 months after the original operation. This is the time required for the skin to retract, for...

Superior Pedicle Vertical Scar Mammaplasty Surgical Technique

Breast Reduction Scarring

I first tried the vertical reduction technique to minimize scars but have stayed with it because I saw improved results that hold up over time. It is my preferred method for breast reduction and mastopexy. Vertical scar techniques have not gained popularity in the United States as rapidly as in Europe and South America. The reluctance to abandon the Wise pattern in favor of the vertical reduction has been related to concerns over the safety of the superior pedicle and familiarity, satisfaction, and comfort level with the inferior pedicle and central mound techniques, which enjoy tremendous popularity in the United States. However, over the past few years there has been greater interest in short scar breast surgery in the United States with increasing application of the vertical techniques for reduction and mastopexy. The original Wise pattern was designed to support and shape the breast through skin excision, the so-called skin brassiere. Short scar techniques all rely on shaping the...

Scrape Ulcer Or Scar On The Cornea

A corneal scar is a painless, white patch on the cornea. It may result from a healed corneal ulcer, burn, or other injury to the eye. If both eyes are blind but the person still sees light, surgery (corneal transplant) to one eye may return its sight. But this is expensive. If one eye is scarred, but sight is good in the other, avoid surgery. Take care to protect the good eye from injury.

IL10 Causes Scarring in a Model of Fetal Wound Repair

Fetal wound healing is characterized by rapid reepithelialization, minimal inflammation, and scar-free repair (reviewed in ref. 76). Fetal wounds also show diminished expression of the proinflammatory cytokines IL-6 and IL-8, a phenomenon that was hypothesized to be owing to their negative regulation by the antiinflammatory cytokine IL-10. To test this hypothesis, Liechty et al. (77) wounded embryonic skin from IL-10 null mice that had been grafted onto strain-matched adult mice. Wounds of control embryonic skin grafts showed little inflammation and normal restoration of dermal architecture. However, wounded IL-10 null grafts showed significantly higher inflammatory cell infiltration and collagen deposition more akin to the scarring associated with adult repair. This study suggests that IL-10 plays an important role in regulating the expression of proinflammatory cytokines at the fetal wound site, and thus modulates downstream matrix deposition that leads to scar-free repair.

Of a Chorioretinal Scar

A critical step in retinal detachment repair is the development of the chorioretinal scar around the retinal break. The most important effect of cho-rioretinal adhesion in closing the retinal break is to induce a watertight seal that prevents seepage of vitreous fluid into the subretinal space 5, 23 . Although the mechanism producing the laser-induced bond within the first days after photocoagulation is uncertain, histologic studies have shown that a proteinaceous coagulum develops at the interface between the retina and the retinal pigment epithelium, followed by cicatricial adhesion due to proliferation and migration of glial cells into the wound site 6, 12, 24 . In clinical practice, a correlation with these histologic findings can be established postopera-tively. During the first 5 days, the laser spots are surrounded by retinal edema (Fig.10.2a). Over the following 7 days, the retinal edema disappears (Fig. 10.2b). Finally, in the second week, a chorioretinal scar develops (Fig....

Reducing Facial Scars

As discussed in chapter 6, resurfacing with the erbium YAG laser is a very effective treatment for facial scars. Resurfacing is most effective for small diameter, superficial scars. Large-diameter, deeper scars require adjunctive treatments that result in elevation of the scar or thickening of the depressed skin within the scar. One such treatment is subcision, a minor surgical procedure done under local anesthesia. In this process, a hypodermic needle is used as a small surgical scalpel to slice through scar tissue bands below the type III scar. Releasing the scar tissue allows the bound down skin to elevate. The injury produced by subcision heals with the production of additional dermal tissue (collagen), which also contributes to thickening of the skin within the depressed scar, thus elevating the depression. Because the skin surface is essentially undisturbed by subcision, these treatments produce little immediately noticeable effect other than minor bruising or swelling. All the...

Revisions Related to Scars

Hypertrophic or keloid scars can occur with any surgical episode, and the standard treatment protocols of pressure dressing, silicon gels, and or local corticos-teroid injections should be employed as necessary. Most scars respond to conservative treatment. Persistent reddish or dark scars can improve by pulsed ruby laser therapy. Resistant keloid scarring with significant symptoms (pain, irritation, pruritis) may occasionally require reexcision and brachytherapy (iridium threads). It is rare to see scar hypertrophy of the vertical limb after breast reduction when it does occur, it is usually at the inferior pole of the vertical scar if it crosses the inframammary fold (IMF). In fact, the low rate of vertical scar hypertrophy is one of the major advantages of vertical scar techniques they bypass many of the difficulties of the inverted T scar techniques. Fig. 14.1 a-c. A 29-year-old patient who had a moderate breast reduction using the septum-based lateral mammaplasty (SLM, Dr....

Fire scars

Another type of hollow often observed in eucalypts is the fire scar. Fire scars form at the base of trees (Figure 4.4C) and are also called basal hollows or butt hollows. Hollows at the butt created by fire scars occurred in 2-12 of eucalypts measured in southern NSW (Linden-mayer et al. 2000c). Of all trees in unlogged damp sclerophyll forest in East Gippsland and south-eastern NSW, 16 contained fire scars (Gibbons 1999). In forest dominated by fire scars, main stem hollows and hollows in branches of the crown. For main stem and crown hollows, the proportions are of all living trees with hollows. For fire scars, the proportions are of all trees on unlogged sites. Data are primarily from Brown Barrel, Messmate, Gippsland Peppermint and Mountain Grey Gum in East Gippsland, Victoria. (Source Gibbons 1999.) fire scars, main stem hollows and hollows in branches of the crown. For main stem and crown hollows, the proportions are of all living trees with hollows. For fire scars, the...

Q Waves as Scars

Crown Infarction

It was mentioned earlier in the chapter that the ST elevation and T wave inversion seen in STEMI frequently resolve over time, but that the Q wave may persist indefinitely as evidence of a past infarction. Pathologic Q waves in the absence of AMI are therefore sometimes referred to in ECG reports as scars or remote infarctions. Figures 9.10 and 9.11 show remote inferior and anterior infarctions, respectively, in which the ST elevation and T wave inversion have resolved but Q waves persist as evidence of the old infarction. Close inspection of the acute inferior myocardial infarction shown in Figure 9.9 also reveals a pathologic Q wave in V and V2, indicating an old anteroseptal wall infarction.

Impaired Wound Healing

Therapy, beyond direct effects at the site of wounding, may add further to impaired nutritional status (6). In such patients subjected to surgery, there is an increased risk of wound-healing complications (7). Diabetes is often associated with poor wound healing, which is related in part to alteration in granulocyte function, altered microvasculature, and frequently coexistent atherosclerotic vascular disease (8,9). Local infection is one of the single most important causes of defective wound repair (10,11). The development of a major wound infection in a surgical incision can lead to a complete failure of healing by primary intention. When ultimately healed by secondary intention, such wounds experience impaired wound strength and often contain excessive scarring. Additional, well-recognized factors that can lead to impairments in repair include aging (7,12,13) anemia and hypoxia (14) jaundice (15) uremia (16) use of steroids (17,18) and local factors including irradiation treatment...

A Anastomotic Aneurysms

On examination, the patient appeared well. There was a well-healed midline laparotomy scar from the previous operation. Abdominal examination was unremarkable, and there were no bruits on auscultation. Two well-defined expansile masses were palpable in the middle third of the femoral scars, measuring approximately 2 cm on the left and 4 cm on the right. The masses were not tender. There was no evidence of compromise in the distal circulation, and all pulses were palpable. Duplex imaging was performed, which identified anastomotic false aneurysms in both groins, measuring 1.8 cm on the left and 3.5 cm on the right.

Inflammatory Bowel Disease Surveillance

In this patient population with history of colitis and possible prior segmental colonic resections, fistulas and strictures often develop at the anastomosis and make passage of the colonoscopy device impossible. Scarring of the mesentery may also cause rigidity and may lead to failed colonoscopies. Historically, patients would then go on to double contrast barium enema for complete evaluation of the colon.

Mice Lacking FGF2 Show Delayed Reepithelialization

The TGF-P superfamily encompasses a diverse range of proteins, many of which play important roles during development and differentiation. Mammalian members include TGF-P1-3, bone morphogenetic proteins (BMPs), Mullerian inhibiting substance, inhibins, and activins (reviewed in ref. 33). Their biological effects are mediated by heteromeric receptor complexes, which signal via activation of intracellular Smad signaling pathways (reviewed in ref. 34). TGF-P is one of the most studied molecules in the wound-healing scenario. This growth and differentiation factor is found in large amounts in platelets and is also produced by several cell types that are present in a wound, including activated macrophages, fibroblasts, and keratinocytes (35). Three TGF-P isoforms (TGF-P 1, TGF-P2, and TGF-P3) are present in mammals and have both distinct and overlapping functions. In vitro, these molecules have been shown to be mitogenic for fibroblasts, but they inhibit proliferation of most other cells....

Mice Overexpressing TGFP 1 Show Severely Impaired Late Stage Wound Repair

In contrast to the knockout approaches described above, Shah et al. (47) investigated the effect of excess levels of TGF-P 1 on wound repair. Their hypothesis was that elevated levels of circulating TGF-P 1 would accelerate healing but also enhance scarring. Mice with elevated plasma levels of active TGF-P 1 were generated by cloning a modified porcine TGF-P 1 construct, generating constitutively active TGF-P 1, downstream of the mouse albumin promoter region. Using a dorsal incisional wounding model, complemented by ventral sc implantation of polyvinyl alcohol (PVA) sponges, Shah et al. (47) were able to study both normal cutaneous wound repair and cellular infiltration as a model of granulation tissue formation.

Burns scalds and minor injuries

The practice nurse is often consulted for advice and management of minor injuries, burns and scalds during the daily surgery. This chapter looks at the treatment of these conditions, because they are relevant to all community nurses. Recommendations are made as to which patients will require specialist advice. The aftercare of donor sites and management of scar tissue are also discussed. It is recognised that specialist centres may have their own regimen for the care of these wounds, and the reader is expected to follow local protocols.

Anatomy and Pathogenesis of the Urethral Injury

Tion injury of the rectum is critical to identify but rarely seen with pelvic fracture trauma 17 . The life-threatening injuries take precedence in diagnosis and management over the urethral injury, but in those patients who survive, the urethral injury will be the source of chronic complex disability and morbidity. Urinary incontinence in the male depends on the bladder neck proximally and the external sphincter distally. The distal external sphincter mechanism may be destroyed by this posterior urethral injury or during subsequent reconstruction and continence will, therefore, be dependent on bladder neck function alone. Most men, however, are continent following repair of this injury and will reveal a closed bladder neck on preope-rative cystography and cystoscopy. A few patients will be noted to have a persistently open, funneled bladder neck or a bladder neck quadrant scar seen on transvesical cystoscopy, which support the potential of a concomitant bladder neck injury.

Outward signs of occupancy

Observing hollows until animals emerge or enter can be a resource-intensive exercise. Alternatively, some hollow-nesting species leave clear evidence that the hollow, or tree, has been occupied. Many cockatoos and parrots chew the entrance of the hollow or other parts of the nest tree, behaviour which is important for maintaining the health and condition of the beak (Rowley 1990). However, birds often chew vigorously around the nest hollow, which suggests that chewing has other functions. Species that mark the nest tree permanently are among those that show high fidelity to a nesting hole. The Galah, for example, defends its nest hollow even outside the breeding season and will frequently re-use the same nest hole in successive breeding seasons (Rowley 1990). The Gang Gang Cockatoo also marks its nest tree with visible scars and shows fidelity to the same hollow over successive breeding seasons (P. Gibbons, personal observation). Marking the area around the hollow may therefore be a...

Herpes Zoster Ophthalmicus

Most ocular herpetic infections arc caused by HSV-1. Primary infections present as unilateral follicular conjunctivitis, blepharitis, or corneal epithelial opacities recurrences may take the form of keratitis ( 90 of cases are unilateral), blepharitis, or keratoconjunctivitis. Branching dendritic ulcers, usually detected by fluorescein staining, are virtually diagnostic deep stromal involvement may result in scarring, corneal thinning, and abnormal vascularization with resulting blindness or rupture of the globe.

Get advice on whether surgery is needed

Unfortunately, the child will probably need surgery, to release the scar. Without this surgery, the child will not be able to open his mouth properly. You may also need a dentist's help at this time. The child's jaws may need to be wired. The wires are put on the healthy teeth in a way that holds the mouth open while the tight scar is forming. When the wires are removed, the child will be able to open and close his mouth to chew food.

Clinical Features

Secondary lesions last 6-9 months. They are composed of a macular or papular eruption with multiple erosive and crusty lesions that predominates in the limbs. There can be anogenital condylomata. There is generalized adenopathy, and there can be osteoperiostitis of the long bones that causes nocturnal pain. Tertiary lesions appear 6 months to several years after the primary lesion.They appear in the nasopharynx, larynx, skin and bones. They are destructive gummas that ulcerate and leave atrophic scars, often geometrical. Lesions of the palate and nose are destructive and disfiguring. There is also syno-vitis, uveitis, choroiditis and chorioretinitis.

The Fibroblast Populated Collagen Lattice

The healing of dermal defects requires the replacement and integration of a new connective-tissue matrix at the repair site. The deposition and organization of that new connective-tissue matrix entails the interaction between fibroblasts and collagen. A better understanding of those interactions may lead to a more rapid closure of wounds and will reduce the frequency of abnormal scarring. An approach to better understand that process is through in vitro models. One such model is the fibroblast-populated collagen lattice (FPCL), introduced by Bell and colleagues (1).

Condition Of The Middle Eartympanic Membrane Perforation

Treatment should not include medications in the ear or any packing of the ear. Keep the ear dry and clean. An external dressing is recommended. Oral analgesia is not usually needed. The patient should be restricted from flying, swimming, or heavy contact with loud noises. Keep water out of the ear. Systemic antibiotics should be given only if infections occur. Evacuation is not urgent unless a flap is present. If there is only a small perforation, called a pinhole, no treatment is necessary. Some complications of this condition are the failure to heal spontaneously, ear infection, and scarring.

Critical Assessment

Nearly all publications mentioned that for renewed strictures instant urethrotomy, transurethral resection of scar tissue 54 , or an open urethroplasty 30 may be necessary. The incidence of urethral stricture relapses can be reduced by narrow-meshed urethral bougineages.

Granuloma Inguinale Donovanosis

A vulvar nodule breaks down, forming a painless, beefy red, highly vascular ulcer with fresh granulation tissue without regional lymphadenopalhy. Lymphatic obstruction can result in marked vulvar enlargement. Chronic scarring can lead to lymphatic obstruction.

Fluorescein Angiography

Vogt-Koyanagi-Harada disease. Exudative retinal detachments (a) scars of Dalen-Fuchs nodules (b) typical regularly distributed hypofluo-rescent dark dots indicating numerous choroidal granulomas (ICGA) (c) hypofluorescent dark dots surrounded by indistinct fuzzy choroidal vessels (ICGA) (d, top frame) showing normalization after only 3 days of pulse intravenous corticosteroid injections (d, bottom frame) fluorescein angiographic image of exudative retinal detachments (e) Fig. 15.1 a-e. Vogt-Koyanagi-Harada disease. Exudative retinal detachments (a) scars of Dalen-Fuchs nodules (b) typical regularly distributed hypofluo-rescent dark dots indicating numerous choroidal granulomas (ICGA) (c) hypofluorescent dark dots surrounded by indistinct fuzzy choroidal vessels (ICGA) (d, top frame) showing normalization after only 3 days of pulse intravenous corticosteroid injections (d, bottom frame) fluorescein angiographic image of exudative retinal detachments (e)

Pathogenesis And Immunity

In both ocular and genital infections caused by C. trachomatis, the initial polymorphonuclear leukocytic (PMN) response is followed by a mixed infiltrate comprising lymphocytes, PMNs, plasma cells, macrophages, and eosinophils.38 In the conjunctiva, urethra, and endocervix, the lymphocytes and other mononuclear cells aggregate to form lymphoid follicles with B cells and macrophages in the center, surrounded by a peripheral region comprised of T cells. An enhanced inflammatory response occurs following repeated reinfections both in naturally occurring infections and in animal models of both ocular and genital tract disease. These enhanced responses result in rapid clearance of C. trachomatis and thus increased difficulty in recovering the organisms from infected sites. Unfortunately, the severe inflammation also results in enhanced tissue damage and the formation of scars. These scars are a direct cause of the sight-threatening sequelae of trachoma,

Clinical Symptoms and Findings

Anterior chamber inflammation is absent to slight at most. Vitreous infiltration is usually present and can be prominent in some cases. At the onset of disease, fundus examination shows papillitis, vasculitis of veins but very few cream-coloured lesions so typical for BC. However, sub-clinical choroidal involvement is clearly shown by ICGA that reveals numerous hypofluorescent dark dots indicating choroidal stromal infiltration (Fig. 15.3 a). The extent of retinal involvement is shown by FA, which, in addition to vas-culitis of large vessels, reveals massive capillary exudation to the point that there is not enough fluorescein to mark the large veins 35 (Fig. 15.3b). In our experience, cystoid macular edema is less frequent than reported in the past and occurs in up to 40 of cases at any time of the evolution of the disease. For ongoing disease the fundus examination reveals progressively more cream-coloured oval fundus lesions despite corticosteroid immunosuppressive therapy, which...

Type of Tamponade Agent for Inferior Breaks

Fig. 10.2 a Second postoperative day. Confluent diode laser spots around the borders of the retinal break and retinal edema are evident. The retina is completely attached. b Tenth postoperative day. Retinal edema decreases. Note the change in color of the laser spots. c One month postoperatively. A chorioretinal scar has developed around the borders of the retinal break

Use of High Throughput Microarray Membranes for cDNA Analysis of Cutaneous Wound Repair

Hypertrophic scar formation represents an abnormal wound-healing response following thermal injuries or partial-thickness wounds. Specific growth factors, cytokines, extracellular matrix molecules, and proteinases that are known to alter cell proliferation and migration have been implicated in the generation of hypertrophic scars. However, the etiology of hypertrophic scarring has not been identified. Given the complex molecular mechanisms of wound repair, differences in expression of isolated functional genes alone may not sufficiently explain clinical variations. Other genes, such as transcriptional regulators, control response to injury and may provide a more comprehensive explanation for the different responses to injury. Gene expression by Northern blot analysis or in situ hybridization (ISH) to determine levels of mRNA in tissue samples limits the study of tissues to a single gene and requires a large amount of sample. Reverse transcriptase polymerase chain reaction (PCR) and...

Diagnosis and Evaluation of Urethral Strictures

Normal Retrograde Urethrogram Images

Knowledge of the location, length, depth, and density of the stricture (i.e., spongiofibrosis) are critical to planning appropriate treatment. Radiographs, urethroscopy, and ultrasound can be used to determine stricture location and length physical examination and ultrasound will reveal the depth and density of the scar in the spongy tissue. The appearance of the urethra can be determined in contrast studies and the amount of elasticity noted on urethroscopy. In contrast, to ensure that all the involved urethra is included in the reconstruction, it is imperative to completely evaluate the urethra proximal and distal to the stricture with endoscopy and bougienage during surgery. Although hydraulic pressure generated by voiding can keep segments proximal to the stricture patent, unless they are included in the repair, they are at risk for contraction after the narrow-caliber segment obstruction is relieved with reconstruction. Therefore, areas of the urethra proximal to a narrow-caliber...

Laser Resurfacing with the ErbiumYAG Laser

Erbium Laser Before And After

I studied Betacaine as an anesthetic for erbium YAG laser resurfacing over a period of 18 months and reported the results at the 1999 meeting of the American Society for Lasers in Medicine and Surgery. Betacaine was used in 70 consecutive patients who underwent erbium YAG laser resurfacing of facial areas during this period. Resurfacing was done for the purpose of smoothing wrinkles as well as scars from acne and chickenpox. Of 178 facial areas treated, 160 were adequately anesthetized with only the topical Betacaine. Facial areas that failed topical anesthesia were numbed using injected anesthetics at the patient's request. In this study, the overall success rate of topical anesthesia for erbium YAG laser resurfacing was 95 . Fig. 6.1 shows before and after photographs of one of the patients treated in this study. Note that with proper technique even deep wrinkles can be removed completely with the erbium YAG laser. The erbium YAG laser is particularly useful in resurfacing facial...

Sphincteric Incompetence

Doing Kegels With Catheter

Klutke et al. (72) introduced antegrade placement of collagen through a suprapubic tract. The rationale is to inject collagen into supple, well-vascularized tissue above the scar of the vesicourethral anastomosis to improve results. Utilizing this technique, Klutke et al. achieved dryness in 25 of patients and 45 were significantly improved (73). Vasavada and Appell (74) presented long-term follow-up in 29 men treated with the antegrade collagen injection technique. The initial (2 wk) dry rate was 76 . The dry rate decreased to 66 at 6 mo and 24 at 1 yr. These authors concluded that early success is not predictive of a long-term outcome. From these data, it is apparent that collagen injection therapy is not the ideal treatment of incontinence following prostatectomy. Patients selected should be those with mild to moderate stress incontinence, and they should be counseled that multiple injections will be needed. It is important to stress that social continence is a more realistic goal...

Subcutaneous Wound Tissue Oximetry

Make a small stab wound with a no. 11 blade at the planned entry and exit sites. The stab wound should be large enough to allow easy passage of the catheter, but as small and superficial as possible, in order to minimize bleeding. Make the stab wound in line, with skin lines to minimize or eliminate scarring.

Two Stage Meshgraft Urethroplasty

Elastic Penis Meatus

Most uncomplicated strictures of the anterior and posterior urethra are successfully treated with a one-stage procedure. Among these procedures are stricture resection and consecutive end-to-end anastomosis or contemporary methods of tissue transfer such as flap procedures. However, complex strictures with significant scar tissue formation of the urethra, strictures that have undergone prior repeated surgery, and urethra malformations found in severe hypospadia cases continue to present a challenge for surgery. The problems arise from a lack of the healthy elastic tissue needed to reconstruct the urethra. This applies in particular for long strictures that involve the entire length of the urethra. Although the two-stage mesh-graft procedure as a safe operation can be used for every type of stricture, its real advantage is apparent when used for complex strictures, especially when there is severe scar tissue formation and absence of healthy penile skin for reconstruction of the...

Endoscopic Urethroplasty

Metal Sounds For Urethral Dilatation

Pansadoro V, Scarpone P, Emiliozzi P (1993) The endoscopic treatment of membranous urethral strictures. J Endourol 7 Suppl 1 111 Endoscopic realignment is a safe and effective procedure for the treatment of post-traumatic membranous urethral disruption. A minority of patients heal without urethral stricture and require no further treatment. The subsequent treatment of patients who develop a stricture is easier because the length of the stricture is short, with a small amount of scar tissue. Early endoscopic realignment in stable patients is our first option. However, larger series are needed before early endoscopic realignment of membranous urethra disruption is accepted worldwide as a standard option. Endoscopic realignment of membranous urethral disruption has several advantages when compared to suprapubic cystostomy, followed by late repair. The procedure is relatively easy to perform, with low morbidity. After placement of suprapubic bladder drainage, preoperative antegrade and...

Urethrocystography Voiding

Catheter Lab Abnormal And Noramal Scans

The endoscopic technique 4, 5 is based on three surgical principles 1) only complete section of the block of scar tissue can achieve definitive good results 2) a strip of epithelial tissue is preserved at the 6 and 12 o'clock positions in order to hasten the epithelialization process at the stricture site and 3) hydraulic self-dilatation will maintain the operated membranous urethra open while the process of epithelialization is in progress. Fig. 10.1A-D. Operative technique. A Incision of the scar tissue at 3 and 9'clock. B The block of scar tissue is divided into two halves, upper and lower. C Resection of the scar tissue is performed, leaving a strip Fig. 10.1A-D. Operative technique. A Incision of the scar tissue at 3 and 9'clock. B The block of scar tissue is divided into two halves, upper and lower. C Resection of the scar tissue is performed, leaving a strip positions with a cold knife in order to preserve the mucosa at 6 and 12 o'clock. The two incisions are prolonged with a...

In Inflammatory Choriocapillaropathies

In the convalescent phase there is a delayed regression of FA signs (hyperfluorescence and staining) as compared to the regression of ICGA signs. In the case of chorioretinal atrophy, window effect and masking effect due to chorioretinal scarring are seen. ICGA 2 in post-acute phase, ICGA hypofluo-rescent areas representing choroidal atrophy and scarring FA 3 in post-acute phase, zones of alternating areas of window effects and masking effects indicating chorioretinal atrophy and scars viral or other infectious or systemic trigger at the origin of inflammatory choriocapillaro-pathies. We have previously described a case of APMPPE that developed just after an episode of mumps in a young adult 17 . APMPPE has also been described following acute group A strep-tococcal infection 18 . Furthermore both MEWDS and APMPPE have been described after hepatitis vaccinations 19-21 . Rather than choriocapillaris disease caused by one given infectious trigger, the pathologic process is probably that...

Longterm Urologic Management

The use of a chronic indwelling catheter is never desirable because of its complications including epididymitis, urethrocutaneous fistula, traumatic hypospadias, and squamous cell carcinoma. Yet, chronic catheterization remains the most common form of management in patients who are tetraplegic and bedridden. Many female patients, unable to use an external collecting device, are managed with catheter drainage because they fail pharmacologic therapy and or have limited hand function. McGuire followed 35 women managed with either an indwelling catheter or CIC for 2-12 yr following spinal-cord injury and found a significant reduction in the incidence of autonomic dysreflexia, febrile UTIs, pyelonephritic scarring by I VP, and bladder stones in patients managed with intermittent catheterization. This same study showed 92 of women with long-term indwelling catheters eventually had incontinence around the catheter and 54 had urethral erosion, whereas none on CIC had these complications (51)....

Success Rate Of Gore Tex Thyroplasty

Gore Tex Thyroplasty

Arytenoid adduction is usually performed under local anesthesia. This allows the vocal results to be assessed intraoperatively, and avoids the problem of an endotracheal tube that blocks adduction of the glottis however, it can be performed under general anesthesia by placing sufficient tension on the adducting suture to achieve maximal anterior motion of the muscular process. This generally results in appropriate adduction of the vocal fold when the patient is awake and extubated. A general anesthetic is most useful in anxious or immature patients or in those where surgical dissection is hindered by scarring, obesity, or presence of a tracheotomy.

Removing Vascular Skin Lesions

Treatment of small (one-eighth inch or less) hemangiomas with krypton or argon lasers is relatively painless and requires no anesthesia. Very small lesions will shrink and disappear immediately, healing with no visible scar. Larger lesions may turn gray and heal by forming a scab. A scab forms because the epidermis overlying the heman-gioma is destroyed and the blood within the hemangioma, now coagulated, is on the surface. (A scab is dried, coagulated blood on the surface of the skin.) Larger hemangiomas are more difficult and painful to treat. These lesions may require an injected anesthetic before treatment. The laser energy may need to be administered through repeated pulses or even continuous, non-pulsed treatment. Large lesions, because of their size, absorb a large amount of laser energy and are heated to a relatively high temperature. If enough heat is conducted to adjacent skin, there will be a localized burn, possibly resulting in a wound that heals with a visible scar....

The answer is a Fauci 14e pp 14511455 Massive lifethreatening hemoptysis is 100 cc of blood in 24 h The most common

The answer is d. (Tintinalli, 5 e, p 1568.) Tracheal stenosis may occur days after intubation and is a sequela of the balloon cuff of the tracheal tube pressing against the tracheal wall causing necrosis and scar tissue formation. Patients are typically hoarse and dyspneic. 126. The answer is d. (Fauci, 14 e, pp 1429-1436.) Persons in certain occupations, such as asbestos mining, shipbuilding, construction, insulation, automobile brake repair, pipe fitting, plumbing, electrical repair, and railroad engine repair are at risk for asbestos exposure. Even persons handling the clothes of the person exposed to asbestos are at risk for asbesto-sis (bystander exposure). Asbestosis means that the patient has developed pulmonary fibrosis, scarring (plaques), and calcification. Asbestosis is a bilateral disease that starts from the bottom of the thorax and works upward, so it is not uncommon for the diaphragm to be involved early on in the disease process. Patients with asbestosis are at...

Aortofemoral Graft Infection

A 66-year-old man, an ex-smoker with hypertension and hypercholesterolemia, had undergone a Dacron bifurcated aortic graft and bilateral ureteric stents for an inflammatory aortic aneurysm with ureteric obstruction at another hospital 4 years previously. The left limb of the graft had been anastomosed to the common femoral artery and the right limb to the common iliac bifurcation. Postoperatively he had suffered a mild groin wound infection, which had healed with antibiotics. At follow-up he complained of left calf and thigh claudication. On examination, he appeared generally well with a midline abdominal scar and a left vertical groin scar. He had good right femoral pulse but an absent left femoral pulse.

Mechanism for FPCL Contraction

Dermis Wound Healing Contration

The reorientation and reorganization of collagen both in vivo and in vitro requires cell participation. A widely held idea is that a specialized cell, the myofibroblast, is responsible for wound contraction and the reorganization of collagen. The myofibroblast is identified by the presence of the a-smooth muscle isoform of actin within its cytoplasmic stress fibers (4). Myofibroblasts are fibroblasts with prominent a-smooth muscle actin stress fibers that have been identified in open wounds undergoing wound contraction, in scars undergoing scar contracture, and in other contractile fibrotic disease processes such as Dupuytren contracture (5). In vitro myofibroblasts have been identified in monolayer culture, where they represent 5-20 of the cell population. Populations of fibroblasts in culture will spontaneously develop into myofibroblasts. Myofibroblasts spontaneously appear in areas of high cell density, such as in confluent monolayer cell layers in vitro as well as in granulation...

Recommended Outcomes to Measure Healing After Thermal Injuries

Scarring Cutaneous scarring can be quantified macroscopically using a standard 100-mm visual analog scale ranging from no apparent scar to worst possible appearance (10). Furthermore, it is possible to measure the proportionate amount of reduction in the residual wound surface area by dividing the surface area of the scar by that of a control site (whose dimensions are identical to those of the aluminum bar) marked with a tattoo at the time of the original injury. Histologically, a scar is characterized by pale-staining, thin collagen bundles, typically oriented parallel to the epidermis. Less complex in structure and containing less collagen than the thick, woven normal dermal collagen bundles, scar collagen appears dark compared to normal dermis by examination under polarized light. The scar appears dark mainly owing to the diminished collagen content and results in less light refraction. The polarizing filters can be rotated to enhance scar detection. However, the more...

To the Nipple Areola Complex NAC

Stop Hypertrophic Scars Around Areola

If the NAC demonstrates venous insufficiency at the end of surgery,liposuction of the pedicle may provide instant relief of any tension. Should the NAC congestion persist, the surgeon is duty-bound to reopen the breast and resite the pedicle in a better position. Immediate postoperative edema and swelling may cause NAC venous congestion, too, and release of the periareolar stitches is recommended in this case. Manual massage of the NAC can help to improve the venous return but should be performed with care and propriety Medicinal leeches are not recommended because of the increased risk of infection, which may result in total NAC necrosis. Despite all these measures, partial NAC necrosis can still occur and is often better treated conservatively. This usually produces a discolored scarred region, which can later be corrected by simple scar revision with or without tattooing. Rearrangement of the breast skin envelope coupled with increased tension on the skin closure due to swelling or...

Hidradenitis Suppurativa

Hidradenitis Suppurativa

This is a chronic inflammatory disease occurring on skin containing apocrine glands. It is commoner in women and occurs in the anogenital area as well as the axillae, breasts, thighs, and buttocks. It is a problem of follicular occlusion with the consequent complications of obstruction to the outflow of other apocrine and sometimes sebaceous glands (18). It can be associated with similar conditions such as conglobate acne and pilonidal sinus. Bacteria play a secondary but important role, in the inflammatory process that results leads to scarring and sinus formation. The onset of the disease is after puberty, suggesting that there is a hormonal influence. The skin lesions include comedones often with two pores (bridged comedones), pustules, tender dermal nodules, abscesses, and linear sinus tracks (Fig. 12A and B). Lesions can ulcerate and there is often a persistent purulent discharge. There may also be the complications of episodic cellulitis, fistula formation to the bladder and...

Procedures Done in Advance of Laser Resurfacing

For patients with extensive sun damage, full-face resurfacing with the CO2 laser is perhaps the single cosmetic surgery that can result in the greatest overall facial rejuvenation (see chapter 6 and figs. 6.3 and 6.4). The tightening of facial skin that results from this procedure can even afford some improvement in the loose skin of the neck. (The neck itself can also be resurfaced, but neck skin heals more slowly and is at significantly increased risk of scarring if resurfaced.) The majority of patients who are candidates for full-face I have found that the S-lift minimum incision facelift results in remarkable improvement and achieves most of the results of a standard facelift. Compared to conventional facelift surgery, this mini-facelift has several advantages. One is that this procedure can be done entirely with local anesthesia. Other advantages include minimal bruising and swelling and a very rapid recovery, usually in only a few days. (In fact, some of my patients have...

Appendiceal Stump Odematous Colonoscopy

Appendiceal Stump Coloscopy

False positive diagnosis scar after polypectomy a axial image shows a focal mucosal thickening in the descending colon (arrows) b corresponding endoluminal 3D image confirms the presence of a mucosal lesion, suggesting a flat lesion (arrows). This patient had a polypectomy three days prior to the examination. Diagnosis scar after polypectomy. Lesson The mucosa appears edematous and prominent after polypectomy, closely resembling flat lesions Fig. 8.36a,b. False positive diagnosis scar after polypectomy a axial image shows a focal mucosal thickening in the descending colon (arrows) b corresponding endoluminal 3D image confirms the presence of a mucosal lesion, suggesting a flat lesion (arrows). This patient had a polypectomy three days prior to the examination. Diagnosis scar after polypectomy. Lesson The mucosa appears edematous and prominent after polypectomy, closely resembling flat lesions

Meaninng Of Tateropox

Smallpox Children

Although infection by smallpox began as an upper respiratory disease, infection became systemic and many organs were infected. The virus replicated extensively in the skin, leading to pocks that could cover the entire body. These pocks left scars, particularly in the facial area, which marked the person for life, and at one time the fear of scar- So great was the fear caused by smallpox that a technique of immunization was developed by the 10th century, called variolation, in which people were deliberately infected by smallpox using dried skin from pox lesions. The infecting virus was delivered by blowing the inoculum up the nose or by inoculation into the skin. Infection via either method led to relatively low mortality, about 1-2 compared with 20-30 following natural infection, and the disease was milder with less scarring. Jenner vaccinated people by placing a drop of vaccinia-containing solution on the skin and then scarifying the skin in some way, allowing the virus to replicate...

Laser Resurfacing with the CO2 Laser

Cold Sore Crusting Stage

There is a limit to how much heat can be safely imparted to the skin by the CO2 laser. Generally, three or four passes are the limit. Too many passes may desiccate the skin and result in excessive heat generation with subsequent laser passes. Such excessive heating can result in a burn injury with resultant scar formation or pigmentary alteration. Care must be taken to use less laser energy in certain areas of the face where the skin is thinner so that not too much of the dermis is affected. Reduced laser energy is also necessary on the eyelids because too much skin contraction of the lower eyelid can result in permanent ectropion (a pulling down of the lid that causes the white of the eye to be overly visible). Postoperative care after laser resurfacing is designed to optimize the rate of re-epithelialization. If healing is delayed, hypertrophy (growth) of dermal tissue may occur, leading to a hypertrophic (raised) scar. Good wound care will maximize regrowth of the epidermis. Most...

Superior Arcuate Line Vocal Fold

Cymetra Vocal Cord Injection Device

There are several important advantages of vocal fold injection vs laryngeal framework surgery these include the ease of bilateral vocal fold injection (when clinically necessary) and the opportunity for direct visualization of the pathologic defect of the vocal fold(s) (paresis, atrophy, or scar) immediately before and during the vocal fold injection procedure. Laryngeal framework surgery, in contrast, involves augmenting the vocal fold from an outside to inside approach relying on fiberoptic imaging and perceptual feedback results to judge an endpoint 9 . A bilateral procedure requires a longer neck incision and more surgical dissection. Some surgeons are not willing to perform bilateral medialization laryngoplasty which Vocal fold lipoinjection is best used to treat insufficiency of glottal closure when the gap is small to medium in size. This is often the case in patients with vocal fold paralysis, paresis, atrophy, and scar. For patients with glottal gaps greater than -4 mm, as...

Breast Hypertrophy Young

Breast Hypertrophy

In mammaplasty achieving an aesthetic shape with the shortest scar possible and longest-lasting results has been the aim of most plastic surgeons. However, no single technique can accomplish all these goals. A great variety of surgical techniques are available. Vertical scar mammaplasty has allowed a significant reduction of scar length by eliminating the horizontal scar, with less resection of skin. As most vertical scar mammaplasties rely on the support of the skin envelope, a greater incidence of recurrent ptosis of the breast and healing problems in the vertical scar, such as wound dehiscence, is expected. To prevent these problems, some authors use additional measures that The lozenge technique is based on the skin markings of Arie 1 , Peixoto's concept of tissue retraction 13,14 , and the inferiorly based pedicle. The major component of this technique and the main difference from the other techniques is the use of the inferiorly based flap called the inferior pedicle that...

Soft Tissue Infections

Erysipelas is caused exclusively by S. pyogenes and is characterized by the abrupt onset of fiery-red swelling of the face or extremities.17 Distinctive features are well-defined margins, particularly along the nasolabial fold a scarlet or salmon-red color rapid progression and intense pain. Flaccid bullae filled with clear fluid may develop during the second to third day of illness, yet extension to deeper soft tissues, bacteremia, and shock occur only rarely. Surgical debridement is rarely required and treatment with penicillin is very effective. Swelling may progress despite treatment, though fever, pain, and intense redness diminish usually within 24 to 48 hours. Desquamation of the involved skin occurs 5 to 10 days into the illness and scarring of the skin does not occur. Infants and

Toxoplasmosis In Humans

Ocular disease Before 1950, virtually all cases of ocular toxoplasmosis were considered to result from congenital transmission (Perkins, 1961). Wilder (1952) identified T. gondii in eyes that had been enucleated. The significance of this finding lies in the way this discovery was made. These eyes were suspected of being syphilitic, tuberculous, or of having tumors. Wilder was a technician in the registry of Ophthalmic Pathology at AFIP, and she routinely microscopically examined the sections that she prepared. She put enormous effort into identifying microbes in these 'tuberculous' eyes, but never identified bacteria or spirochetes by special staining. Then she found T. gondii in the retinas of these eyes. She subsequently collaborated with Jacobs and Cook and found most of these patients with histologically confirmed T. gondii infection had low levels of dye test antibodies (a titer of 1 16), and in one patient antibodies were demonstrable only in undiluted serum (Jacobs et al.,...

Transglutaminase Enzyme Increase The Ts In Retanning In Leather

10 Candi E, Oddi S, Paradisi A, Terrinoni A, Ranalli M, Teofoli P, Citro G, Scarpato S, Puddu P, Melino G Expression of transglutaminase 5 in normal and pathologic human epidermis. J Invest Dermatol 2002 119 670-677. and stabilize the collagen fibril. ECM proteins containing e(7-glutamyl)lysine cross-links show increased resilience to proteolytic decay by MMPs and other proteases. The extracellular pool of TG2 can be supplemented by infiltrating monocytes and fibroblasts. If the insult to the tissue becomes chronic then this cycle continues eventually resulting in the increased accumulation of collagen and scarring. 42 Johnson TS, Skill NJ, El Nahas AM, Oldroyd SD, Thomas GL, Douthwaite JA, Haylor JL, Griffin M Transglutaminase transcription and antigen translocation in experimental renal scarring. J Am Soc Nephrol 1999 10 2146-2157. 66 Badid C, Mounier N, Costa AM, Desmouliere A Role of myofibroblasts during normal tissue repair and excessive scarring Interest of their assessment in...

Operative Design and Markings

Vertical Scar Technique Breast Reduction

There are numerous approaches to breast reduction surgery using a vertical skin resection pattern. Lassus 23-25 usually uses a superior pedicle and does not bevel his resection or undermine the skin. He resects the breast tissue directly down to the chest wall and does not resect the parenchyma along the Wise pattern. His inframammary fold stays in place. Marchac 26 uses a superior pedicle but adds a small horizontal scar or T to the bottom of the vertical incision. Lejour 27-30 uses a superior pedicle and undermines the skin. She sutures the breast tissue up to the pectoralis fascia and gathers the vertical skin incision. Hammond 31 uses an inferior pedicle and takes some of the skin excess into the areolar opening as used in the circumareolar approaches. It is important to note that, in cases of asymmetry, the new nipple position needs to be lowered in the larger breast. The closure of the vertical ellipse and the coning of the pillars not only pushes the vertical scar lower...

Pediatrics and Neonatology

The answer is d. (Behrman, 16 e, pp 2156-2159.) Lead poisoning produces a motor neuropathy and is associated with anemia, a gingival lead line, colicky abdominal pain, and basophilic stippling of red blood cells. Patients with acute intermittent porphyria (AIP) present with recurrent bouts of abdominal pain, confusion, and peripheral and cranial neuropathies. Kernicterus is accumulation of bilirubin in the newborn that may cause neuronal death and scarring. Children with fragile X syndrome present with mental retardation, large ears, and a prominent jaw. The triad of macroglossia, abdominal distension, and constipation is consistent with cretinism. 476. The answer is c. (Behrman, 16 e, pp 1950-1959. Ludman, pp 1-8.) The most likely diagnosis in this patient is acute bacterial otitis media. A mucopurulent discharge in acute otitis media occurs only if the drum perforates otherwise, the tympanic membrane is bulging and erythematous. The organisms responsible for this infection are...

Chronic Critical Limb Ischemia

An 85-year-old male with a history of diabetes, hypertension, hypercholesterolemia, coronary artery bypass, and active tobacco use presented with a gangrenous right first toe. The patient stated that he had no history of trauma to the area, and complained of rest pain in the foot. The patient had been in otherwise good health since his coronary artery bypass 12 years ago. On physical examination, the patient was in no physical distress. The patient had a well-healed median sternotomy scar. Auscultation of the heart revealed a regular rate without any murmurs. He was obese. Abdominal examination revealed no palpable masses. The patient had bilateral femoral and popliteal pulses but no pedal pulses. The patient had bilateral, well-healed scars from the greater saphenous vein harvest sites. The right gangrenous toe was dry without any evidence of infection.

Primary Urethral Obstruction

Diminish Scars Vaginal Area

Primary urethral obstruction is uncommon but a definite entity. The stricture process involves the distal urethra, and makes instrumentation difficult or impossible. The scar formation is circumferential, but is palpable posteriorly. The structured area impinges on the mid urethral sphincter zone but does not generally impair continence function. Often these patients have a history of repeated urethral dilations, and it is never clear whether the dila tions caused the problem or were necessary because of the problem. Diagnosis is obvious. The meatus is hard to visualize and may be impossible to instrument even with a small probe. There is dense scar tissue in the plane between the urethra and vagina, which is easily palpated. Repair involves urethra incision through the stricture area, careful removal of all scar tissue from the entire posterior surface of the urethra and advancement of a U-shaped vaginal flap into the area of the stricture (O Fig. 7.23A-F). O Fig. 7.23A-F....

Vertical Reduction Mammaplasty Using the Medial Pedicle

Historically breast reduction surgery has attempted to combine various skin resection patterns with different pedicles to maintain blood supply (as well as sensation and breastfeeding potential) to the nipple-areo-la complex 7 . Observing principles of limited skin undermining of the remaining breast skin along with a dermoglandular pedicle for the nipple are ideal goals that were satisfied by the inverted T inferior pedicle (or central mound) techniques, and they have achieved wide acceptance. But other skin resection patterns and other pedicle designs have been described over the years - each with its advantages and disadvantages 8-13 . Shorter scar skin resection patterns have been slower to achieve wide acceptance 14-20 .

Hollows in branches and the main stem or trunk

Figure 4.4 The four main types of hollows that occur in eucalypts (A) main stem (B) crown branch (C) fire scar and (D) fissure. (P. Gibbons and D. Lindenmayer) Figure 4.4 The four main types of hollows that occur in eucalypts (A) main stem (B) crown branch (C) fire scar and (D) fissure. (P. Gibbons and D. Lindenmayer)

Electrocardiographic Hallmarks of STEMI

These three changes in the ECG typically evolve over a period of minutes to hours, with ST elevation usually appearing first, followed variably by T wave inversion and Q wave formation. Subsequently, the changes may show slow resolution, usually over a period ranging from days to months. Q waves, however, may persist indefinitely, producing ECG evidence of a scar.

Types of Stress Tests

Two major types of radionucleotide isotopes are normally used to assess myocardial perfusion and viability thallium 201 and Tc 99m (sestamibi, teboroxime, or tetrofos-min). Thallium redistributes to areas of ischemia quickly, whereas sestamibi permits imaging several areas after injection. The SPECT technique is superior to planar imaging. Reversible defects are evidence of myocardial ischemia, whereas fixed defects represent previous infarction and areas of old scarring (15).

Atrophic Vaginitis And Serosanguineous Discharge

The answer is b. (DiSaia, 5 e, pp 619-622.) Different tissues tolerate different doses of radiation, but the ovaries are by far the most radiosensitive. They tolerate up to 2,500 rads, while the other tissues listed tolerate between 5,000 and 20,000 rads. Acute evidence of excessive radiation exposure includes tissue necrosis and inflammation, resulting in enteritis, cystitis, vulvitis, proctosigmoiditis, and possible bone marrow suppression. Chronic effects of excessive radiation exposure are manifest months to years after therapy, and include vasculitis, fibrosis, and deficient cellular regrowth these can result in proctitis, cystitis, fistulas, scarring, and stenosis.

Laser Treatment of Tattoos

The great advantage of Q-switched lasers is that they are very safe the risk of adverse events such as scarring is extremely low. Many tattoos can be completely eradicated with no visible effect on the skin. The disadvantage is that most tattoos require multiple treatments. In contrast, a surgical treatment (such as the CO2 laser) may provide drastic reduction in the tattoo after only one treatment but will always cause a significant scar, which usually looks worse than the tattoo.

Liposuction for Final Tailoring

This drawing shows the outline of the parenchymal re-section.Very little tissue is removed superiorly unless the patient has significant upper pole fullness preoperatively. The tissue resection follows a Wise pattern. It is beveled out laterally and medially but undermined inferiorly. Because the inframammary fold rises with this technique, care must be taken to remove excess subcutaneous tissue in the region between the old and the new inframammary folds - especially just lateral to the breast meridian. Postoperative puckers are less a problem of skin excess than a problem of subcutaneous tissue excess. About 1 cm of fat must be left attached to the dermis to prevent scar contracture

Infection Hematoma Seroma

Delayed healing is not unique to the vertical reduction technique (Fig. i3.6).Wound-healing complications as high as 20-50 have been reported with Wise pattern reductions 23-26 . In our experience, most problems with delayed healing and the need for revisions associated with the vertical technique have been related to skin management. This realization prompted the development of the shape and drape concept, in which the sequence is to shape the breast, drape the skin, and then resect excess skin. The length and placement of the scar reflects skin management. Skin excision in the breast should be thought of in three dimensions. Unidimensional skin excision would include circum-areola techniques, while bidimensional skin excision would add a vertical component to the circumareolar method. The combination of a horizontal skin excision with the vertical and circumareola techniques constitutes tridimensional skin excision. Options for skin excision patterns should be thought of as a...

Revisions Related to Skin Excess

Persistent skin excess, usually the most frequent complication, occurs at the inferior pole of the breast and is reported in approximately 10 of cases of vertical scar mammaplasty. It may be caused by various factors 3. In larger reductions of more than 1000 g, postoperative resolution of swelling can sometimes result in a lax skin envelope in the lower pole. Simple excision of the redundant skin along the previous vertical incision reshapes the lower pole of the breast and restores a pleasing contour without additional scarring. Also, tightening of the lower skin enve- Fig. 14.3 a,b. Immediate postoperative results after the secondary revision of the scar Fig. 14.3 a,b. Immediate postoperative results after the secondary revision of the scar formed, including skin, fat, and glandular tissue. The final result was a vertical scar not extending beyond the inframammary fold formed, including skin, fat, and glandular tissue. The final result was a vertical scar not extending beyond the...

Other Enteric Clostridium Infections Clostridium perfringens

Clostridium perfringens type C has been the cause of both sporadic and epidemic cases of necrotizing enteritis. Clinical entities such as Darmbrand ( bowel gangrene ) in postwar Germany during the 1940s and pigbel97 in the Papua New Guinea highlands have been attributed to this organism, which elicits alpha and beta toxins capable of causing the enteritis. Poor nutrition and episodic dietary indulgence have been associated with these entities, with investigators suggesting that a low level of digestive enzymes in people with low protein dietary intake may prevent normal inactivation of bacterial toxins.98 Clinically, previously healthy patients present with a necrotizing enteritis syndrome that may include anorexia, nausea, vomiting, abdominal pain, and hematochezia and may progress to sepsis. Complications are common and include peritonitis secondary to bowel perforation, ileus, and chronic scarring leading to malabsorption, obstruction, or fistulas.

Owl Technique Breast Reduction

Central Pedicle Technique

Hammond DC (1999) Short scar periareolar inferior pedicle reduction (SPAIR) mammaplasty. Plast Reconstr Surg 103 890 13. Asplund OA, Davies DM (1996) Vertical scar breast reduction with medial flap or glandular transposition of the nip-ple-areola. Br J Plast Surg 49 507 14. Beer GM,Morgenthaler W, Spicher I,Meyer VE (2001) Modifications in vertical scar breast reduction. Br J Plast Surg

The clinical features of congenital ocular toxoplasmosis

Congenital infection is more common later in gestation, but disease manifestations are worse if acquired earlier in gestation (Dunn et al., 1999). Classically, congenital disease is associated with bilateral macular scarring, but acquired infection can also result in macular disease and, rarely, bilateral scarring as well (Glasner et al., 1992). Other manifestations include optic neuritis, iritis, neuroretinitis, retinal vasculitis, acute retinal necrosis, recurrent iridocyclitis, and persistent vitritis. Long-term follow-up of congenitally infected children results in identification of further ocular sequelae not present at birth - for example, in one study four of six untreated congenitally infected children developed scars subsequent to birth during the next 20 years (Koppe et al., 1986). It is estimated that 85 percent of infants untreated and without ocular lesions at birth will subsequently develop ocular toxoplasmosis (Koppe et al., 1974 Wilson et al., 1980). Microphthalmos and...

Septumbased Medial Pedicle SMM

Depending on many factors such as skin quality, age of patient, smoking history, or patient wishes, the decision is made to close the breast with a vertical scar only or short L or inverted T pattern. If the vertical scar is opted for, the skin will be undermined to a limited extension so as to permit closure with small wrinkles (Fig. 9.6b). Skin closure is done in two layers using interrupted 3-0 polydiaxonan on the deep dermis and running subcuticular 4-0 Monocryl on the skin.

Presumed Ocular Histoplasmosis Syndrome POHS

Histoplasma capsulatum is a fungal organism endemic in the Mississippi and Ohio river valleys. Other known endemic regions are Italy, Central America, Turkey, Israel and Australia. In these geographic areas there is a type of multi-focal choroiditis that has distinctive features, called presumed ocular histoplasmosis syndrome (POHS) probably caused by the dissemination of the organism after pulmonary inhalation 57 . Diagnosis of exposure to histoplasma capsulatum is performed by performing histo-plasma capsulatum hypersensitivity skin testing. In the case of a positive skin test and the presence of multifocal choroiditis the diagnosis of POHS has to be considered. In non-endemic areas this terminology should not be applied and the diagnosis of POHS should be questioned unless there is a positive skin test. The criteria that differentiate POHS from multifocal choroiditis are the absence of anterior chamber reaction, punched-out multifocal lesions also in the periphery (histospots) and...

Vertical Mammaplasty The Era of Maturity

Breast reduction is one of the most difficult operations in plastic surgery because it should produce a beautiful, symmetrical, and durable result with minimal scarring. Raymond Vilain, the humorist of our profession, used to say that it takes 5 years to learn how to operate a breast properly and 5 more years for the other. In addition, so many techniques are described that it is a real challenge to choose the best. Twenty years ago vertical mammaplasty was practically unknown by most surgeons performing masto-pexies and breast reductions. Devised by a French surgeon, Dartigues (1925), it was nearly forgotten until Arie (1957) and Lassus (1970) brought it to the attention of their colleagues. I admire Claude Lassus, a man with a vision who understood early that vertical mammaplasty not only reduced scarring but also produced better late results and that this justified the temporary strange appearance of the breasts.

Who is the Ideal Candidate for the Vertical Mammaplasty

In patients who have simple breast ptosis or who require only a small reduction of 400 to 500 g or less, the vertical mammaplasty can provide an excellent aesthetic result. Addition of an aggressive vertical skin resection is particularly helpful in cases of pseudop-tosis, where the lower pole of the breast is excessively prominent. As in any other breast reduction techniques, vertical scar mammaplasty works most easily in moderate-sized breasts with good tissues and elastic skin in young nonsmokers. A patient with normal and stable weight is preferable to an obese patient whose weight is constantly fluctuating. Juvenile patients are more prone unpredictable and often hyper-trophic scar formation, and all efforts should be undertaken to keep scars as short as possible. Patients with large breasts,where the amount of tissue resection exceeds 1000 g per breast, and older patients, where skin has lost its elasticity and the breast has been replaced by adipose tissue, are not good...

Syndromes of Ischemic Heart Disease

Zones Infarct

The continuum of ischemic heart disease stretches from silent ischemia through the various patterns of angina, AMI, and scars of a previous myocardial infarction, to the complications of AMI, such as ventricular aneurysm or pericarditis. Although all of these syndromes represent a continuum of the same disease process, they may present with quite different ECG patterns at different stages of the continuum, and have distinctly different treatments and outcomes. When a patient presents with chest pain, the ECG can help us to determine where they fit on the continuum. Similarly, the nature of the patient's symptoms and the physical examination can also provide clues as to where the patients fit on the continuum, and can lead us to search for subtle ECG changes that we might otherwise overlook without a high index of suspicion.

Proposed Sequence of Events

In the intestine, there are four classic pathologic stages. Hyperplastic changes begin during the first week of illness and primarily involve Peyer's patches of the ileum and solitary lymphoid follicles of the cecum, but may involve any lym-phoid tissue in the intestine. Almost all infiltrative cells are mononuclear typhoid nodules are common. If the hyperplasia does not resolve, necrosis of the intestinal mucosa develops, usually after 7 to 10 days of clinical illness (Fig. 17-3). Sloughing of the mucosa follows and results in the development of an ulcer, which may bleed (see Fig. 17-3). The ulcers conform in shape and distribution to the location of the lymphoid follicles are largest in the ileum, and are almost always found on the antimesenteric border of the intestines. These ulcers may perforate into the peritoneal cavity.64 Perforations are single and measure less than 1 cm in 80 of cases, and 90 are found within 60 cm of the ileocecal valve. When healing takes place, it is...

Selective Photothermolysis the Enabling Principle for Cosmetic Laser Surgery

Hemoglobin Laser Absorption

And a wavelength that was highly absorbed by hemoglobin (relative to other skin chromophores) could be used. Pulse duration had to be shorter than thermal relaxation time so that heat would not build up excessively within the blood vessel and then be conducted to surrounding dermal tissue, causing a burn injury (with resultant scarring).

Epidemiology Definition and Characteristics of Dry

Causes the symptoms that are presented to the ophthalmologist 48 .Symptoms can range over a wide spectrum from mild discomfort and increased fatigue of the eye to redness, itching, burning and stinging sensations (Fig. 6.5). It can be associated with usually minor alterations of visual acuity but may in severe cases lead to severe inflammation, scarring and blinding.

The Use of Free Grafts for Urethroplasty

Duckett Urethral Repair

The flaps used in urethral reconstruction are random island flaps of penile or scrotal skin carried on a dartos pedicle - random, because there is no defined artery supplying them and so for the skin paddle to remain viable, an extensive dartos pedicle must be created. The disadvantage with a flap repair is that it is time-consuming (and tedious) to harvest the flap and the dissection is extensive. This produces scarring and loss of the normal contour of the penis when its dartos layer has been redeployed from part or all of its circumference.

Surgery for Recurrent Veins

Recurrent LSV VVs arise because of inadequate dissection of, or neovascularization at,the SFJ in the presence of a nonstripped or incompletely stripped LSV. Standard teaching is to approach the SFJ through nonoperated tissues (usually from a lateral approach that first exposes the common femoral artery) so that the CFV can be skeletonized of branches using nonabsorbable sutures for 1 to 2 cm above and below the junction. The top of the LSV is dissected from the mass of scar tissue so that it can be stripped. However, this can be a difficult and potentially morbid operation. When the preoperative DU indicates neovascularization as opposed to an intact SFJ, the LSV can be located at the knee, a stripper passed up toward the groin, and the vein stripped without a formal redissection.

Planning the Mammaplasty

Consistency, (b) grade of ptosis, (c) distance between the suprasternal notch and nipples, (d) location of the nipple on the breast, (e) skin quality, and, most important, (f) the relationship between breast tissue and skin. Depending on these factors,it is our opinion that each breast deserves individualized skin markings 1 (not patterns) and individualized tissue resection. In sum, the greater the skin excess in relation to the breast tissue, the more skin will be removed. The amount of skin resected determines the length of the scar. When one tries to reduce the length of the scar by limiting skin removal, the form and appearance of the breasts are usually compromised. In this chapter, first skin markings are discussed, and then the different methods of tissue removal are described.

Different Approaches for Different Breasts

Techniques for breast reduction and mastopexy have evolved, as have philosophical concepts. The goal of a mastopexy or a reduction mammaplasty is to achieve breasts with pleasant appearance and firm, adequate size and form with minimal scarring and low rate of complications. Lactation and sexual functions must be preserved. If performed properly, the results are long lasting. The reason women demand aesthetic plastic surgery on their breasts is that they dislike aspects related to their appearance such as volume, shape, or consistency. Patients who undergo a reduction mammaplasty or mastopexy know beforehand that there will be a scar after the surgery. Every breast is different therefore,every operation is different, and so the scars are different, in quality and appearance, regardless of length. It is the appearance of the scar that matters, not its length.

In the Hands of a Young Surgeon Which Pattern Should be Used in Reduction Mammaplasty

As far as the vertical scar in Lejour's technique (superior pedicle) is concerned, one must admit that some patients do not accept the aspect of the vertical scar with multiple wrinkles in the early postoperative period. Furthermore, scar correction at the bottom of the vertical scar is needed for many patients in our experience. The vertical technique is far more than just a scar it is a concept. Breast shaping and modeling are the most important elements of this technique. We believe in scar reduction, but it should not be done at the cost of a high rate of wound dehiscence and scar revision. The vertical scar can be ended easily with a short horizontal scar if needed. However, in patients who have poor skin quality or long-lasting breast hypertrophy like elderly patients, a short inverted T scar will be more appropriate. Designing the inverted T at the end of the operation provides better scar placement with minimal extension of the scar to the sides. In addition, the skin excess...

Correction of Breast Deformity after Conservative Therapy

Location may lead to a major nipple-areola displacement. The combination of a large amount of scar tissue due both to tumorectomy and axillary lymph node dissection and to irradiation makes the defect too difficult to correct by mammaplasty techniques alone. In this specific case, a locoregional tissue transfer is required. Pedicled flaps from the axillary region may still be available, but pedicled latissimus dorsi, scapular, or perforator flaps might be better options for resolving this problem.

Complications Statistical Review

Recently, in 2003,Berthe et al. 21 published an interesting study in which 170 consecutive patients (330 breasts) underwent the classic Lejour mammaplasty technique from 1991 to 1994. Minor complications, which included seroma, hematoma, partial areola necrosis, and superficial wound dehiscence, were observed in 30 of patients. Major complications, comprising glandular necrosis, total areola necrosis, and glandular infection, were seen in 15 of patients. A surgical revision rate of 28 was necessary in this series. Noting these unacceptably high complication rates, Berthe et al. modified their technique by limiting breast liposuction to the axillary area in large breasts and minimizing skin undermining. Similar modifications have been described by Hall-Findlay 19 . Berthe et al. also performed primary skin excision in the inframammary fold if the excess could not be gathered adequately. The second part of this study, between 1996 and 1999, consisted of 138 consecutive patients (227...

Special Precautions for Very Serious Burns

When someone is badly burned between the fingers, in the armpit, or at other joints, gauze pads with Vaseline on them should be put between the burned surfaces to prevent them from growing together as they heal. Also, fingers, arms, and legs should be straightened completely several times a day while healing. This is painful but helps prevent stiff scars that limit movement. While the burned hand is healing, the fingers should be kept in a slightly bent position.

DPT for diphtheria whooping cough pertussis and tetanus For full protection the child needs 3 injections These are

A single injection is given into the skin of the left arm. Children can be vaccinated at birth or anytime afterwards. Early vaccination is especially important if any member of the household has tuberculosis. The vaccine makes a sore and leaves a scar.

Inflammatory Urethral Strictures

There has been a recent increase in strictures associated with balanitis xerotica obliterans (BXO), which are more like inflammatory strictures than isolated, traumatically induced scars. BXO usually begins with inflammation of the glans and generally leads to meatal stenosis, if not a true stricture of the fossa navicularis. Although the cause of this distal penile skin and urethral inflammation is unknown, recent literature suggests the possibility of bacterial infection with resultant skin changes. There is also some evidence that the progression of the stricture to eventually involve the entire anterior urethra may be caused by high-pressure voiding that leads to intrava-sation of urine into the glands of Littre, inflammation of these glands, and micro abscesses and deep spongi-ofibrosis (O Fig. 8.2). Whether the urethral changes and fibrosis are also related to bacterial injury has not been well defined.

Bypass to the Popliteal Artery

On physical examination, he had bilateral carotid bruits, normal heart examination, and a strong right femoral pulse, but absent popliteal and pedal pulses. His left lower extremity had a saphenectomy scar. Both extremities had shiny, hairless skin without ulcerations or gangrene.

Differential diagnosis

Congenital toxoplasmosis must be differentiated from other possible causes of the classic clinical acronym 'TORCH' for a series of etiologies that share similar signs and symptoms. The acronym includes Toxoplasma, rubella, cytomegalovirus, syphilis, and herpes simplex virus. However, emerging pathogens such as West Nile Virus must be considered as part of any differential in known congenital infection (Alpert et al., 2003). Recurrent toxoplasmosis with its unilateral active lesion associated with multiple adjacent chori-oretinal scars with the appropriate clinical history is virtually pathognomonic. However, clinical syndromes such as serpiginous chorioretinitis, and other infectious etiologies such as cytomegalovirus, may occasionally be considered. For the many other possible and unusual manifestations of ocular toxoplasmosis, such as pars plani-tis, the differential diagnosis is even broader, and includes autoimmune disorders such as multiple sclerosis and infections such as Lyme...

Activation of TLymphocytes by Cytokines

The inflammatory events that occur in allergic eye disease are moderate in the acute seasonal and perennial allergic disease, SAC and PAC, and mainly lead to edema, redness and itching, whereas the immigration of inflammatory cells is limited. However, in the more chronic allergic diseases such as vernal and atopic keratoconjunctivitis (VKC and AKC) there is a more pronounced immigration of inflammatory cells. In chronic allergic eye disease but not, or only weakly, in acute ocular allergy, activated matrix metalloproteinases occur in the tissue and tear film and may explain the occurrence of corneal destruction in the chronic forms. There the inflammatory process can lead to scarring and can have sight threatening complications, especially in AKC. The giant papillary type GPC causes tarsal conjunctival thickening and is of intermediate severity 20,57 .

The Supporting Cast Liver Gallbladder and Pancreas

Lower Abdominal Pain Left Side

The Crohn disease as either the inflammatory form (in which the inflammation may cause an inflammatory mass), the obstructing form (in which the inflammation on the inside of the intestine actually causes the intestinal opening to close off scar tissue from healing inflammation can also close it off), or the fistulizing form (where loops of bowel become connected by a fistula that runs from the inside of one loop to the inside of another).

Wound Repair in Aging

Different age groups (20-40 yr) during World War I. However, the type of wound, infectious complications, and the overall young age of the patients diminished the validity of his conclusions. Halasz (29) reported an increase in the incidence of wound dehiscence with age in 3000 patients having undergone duodenal surgery. Again, concurrent morbidity and infectious complications were not recorded. More recently, the majority of studies have found a delay in healing, but less scarring, in the wounds of aged animals and humans relative to their young counterparts (19,20,22,23,30,31).

Technique and radiation

The optimal time for DMSA scanning remains an unresolved issue. Many units perform the study in the acute phase (i.e., during or soon after a UTI) in order to determine the extent of parenchymal involvement. Critics of such practice point out that an acute abnormality does not necessarily represent a permanent scar and a repeat scan is often required after 3-6 months to determine longstanding injury. Deferring the DMSA scan for such a period of time may avoid the initial examination. To maximize the detection of scarring, various projections should be utilized to image the kidney. Posterior, right, and left posterior views are standard, but anterior views must be included if a pelvic or horseshoe kidney is suspected. Furthermore, in asymmetric kidneys (e.g., ectopic kidneys, scoliosis), anterior views must be obtained and split function expressed as a geometric mean of radioactivity in both posterior and anterior images. Reports in literature have suggested that the use of single...

Nonsurgical Lasers for Treating Skin

Prior to the development of the pulsed dye laser, the argon laser was the best option for treating blood vessels. Introduced in the 1970s, the argon laser produces blue-green light with a wavelength of 514 nm. This color is well absorbed by the hemoglobin molecule in red blood cells and is near a peak in the absorption spectrum of hemoglobin (fig. 4.1), and thus has a selective effect on vascular tissue. This laser was used primarily by ophthalmologists to destroy abnormal blood vessels in the retina that occur in diseases such as diabetes and can lead to blindness if untreated. The argon laser was used with some success to treat cutaneous blood vessels. Most responsive were large facial vessels (telangiectases), which are common in people with the acne-like skin disease rosacea and can also occur in people who have had excessive chronic sun exposure. The physical and optical properties of port wine stains are different from those of telangiectases such that treating them with the...

Aspects of Epidermal Regeneration

As described previously, the healing of skin wounds involves a complex system of integrated molecular signals and interactions among many different types of cells within a wound. For some types of experimental questions, it is desirable to simplify the experimental system and isolate the single variable of interest. Frequently, this is best approached using an in vitro cell culture system. With a single type of cultured cell, the number of experimental variables can be dramatically reduced compared to a similar experiment performed in an animal. For example, if one hypothesized that hypertrophic scars developed because of an increased sensitivity to a growth factor, an important in vitro experiment would be to compare the mitogenic response of cultures of fibro- blasts established from normal skin or from hypertrophic scar tissue to the growth factor. However, simplified in vitro cell culture systems inherently lack other components that may influence the responses of cells in vivo....

Studies with Lower Mammals

Experimental studies of wound breaking strength have commonly utilized guinea pigs, rats, and mice. These animal models of healing do not totally replicate healing in humans. Animals are not as susceptible to wound infections as are humans. Scar formation is significantly less in these animals and is for all practical purposes not problematic.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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