Dermatologic Surgery最新文献

Background: Injectable poly-l-lactic acid (PLLA-SCA) increases extracellular matrix to improve skin quality. The hip dell is an underappreciated element of gluteal aesthetics. Adipose tissue has roles in aesthetics and skin functioning.

Objective: To investigate the efficacy of PLLA-SCA treatment to induce adipogenesis and volumize the hip dell.

Materials and methods: This was a double-blinded, split-body trial of 15 women with hip dell volume deficits. Each subject was randomized to have 1 hip dell treated with 150 mg of PLLA-SCA while the contralateral hip dell received the equivalent volume of saline. Subjects received 3 treatments at 1-month intervals and were followed for 9 months. Assessments included physician global aesthetic improvement scale, ultrasonography, and histologic examination.

Results: Blinded investigators rated PLLA-SCA-treated hip dells as improved and much improved. The dermis and adipose layers increased in thickness by 26.1% and 27%. These measures, in addition to collagen and elastic fiber quality, were significantly improved compared with saline-treated hip dells, which did not change from baseline. Subject satisfaction was also significantly greater on the PLLA-SCA-treated side. No subject experienced significant adverse effects.

Conclusion: Poly-l-lactic acid is a safe and effective method for durable volumization and aesthetic improvement of the hip dell. PLLA-SCA may promote adipogenesis and elastogenesis.

Background: The reliability and security of surgical knots play a critical role in wound closure and healing. A surgeon's knot, created by a modification of the square knot in which an extra 'twist' is added to the initial throw, is often used to increase friction and provide stability of the tissue as the knot is completed.

Objective: The purpose of this study was to quantify the security of sutures, as influenced by varying numbers of initial twists in a surgeon's knot.

Materials and methods: Using pig's feet for simulation, the study compared the security of knots tied with 2 types of sutures in 3 different sizes, examining the impact of 1 to 6 initial twists. Univariable linear regression was performed to evaluate the association between increased twists and the force required to loosen each knot.

Results: These data showed that suture security generally improves with an increasing number of twists, up to 5, beyond which benefits diminish in certain suture sizes.

Conclusion: Increasing the number of twists in a surgeon's knot significantly enhances suture integrity, with optimal results in knot security observed between 3 to 5 twists, suggesting that a balance is necessary between knot security and ease of application.

Background: Patient-reported outcome measures (PROMs) are necessary to assess the value of skin cancer treatment and to better compare therapeutic options.

Objective: To develop and validate the Oxford Skin Cancer Treatment (OxSCanTr) scale, evaluating health-related quality of life and satisfaction after skin cancer treatment.

Materials and methods: After qualitative patient interviews, international expert consultation, and item reduction, 2 separate patient samples were used to assess the factor structure of the scale. Exploratory factor analysis with categorical variables and a polychoric correlation matrix followed by promax oblique rotation was performed to establish a factor structure on Group A. Confirmatory factor analysis with a Satorra-Bentler scaled test statistic evaluating the root mean squared error of approximation (RMSEA), standardized root mean squared residual (SRMR), and comparative fit index (CFI) was conducted on Group B. Reliability as internal consistency was assessed using McDonald omega. Convergent and discriminant validity were assessed using the Pearson correlation coefficient.

Results: A total of 480 subjects returned completed surveys (completion rate 96%). A 12-item scale was developed encompassing 4 domains: aesthetic satisfaction, treatment choice satisfaction, treatment experience, and future concerns regarding recurrence/spread. Confirmatory factor analysis showed excellent goodness-of-fit characteristics, with RMSEA = 0.048, SRMR = 0.051, and CFI = 0.962 using the 4-factor model. Reliability was very good (McDonald omega 0.81-0.82), as was convergent validity with the FACE-Q skin cancer module appraisal of scars subscale (r = 0.55). Discriminant validity with a single question regarding being conservative was similarly excellent (r = -0.02).

Conclusion: The OxSCanTr scale is a parsimonious, feasible, and valid PROM for the holistic assessment of the experience of patients who have undergone skin cancer treatment.