Acne Scars

Cornea. 2009 May 30; Prasher P, Muftuoglu O, Hsiao ML, Bowman RW, Hogan RN, Mootha VVPURPOSE:: To report the clinical and histopathologic findings of 2 patients who developed epithelial downgrowth after Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS:: A 64-year-old woman (case 1) underwent DSAEK for corneal edema secondary to Fuchs endothelial dystrophy in left eye. However, the graft failed to attach, and a repeat DSAEK was performed 3 weeks later. After 4 months, the patient developed herpes simplex virus keratitis that resulted in anterior stromal scarring. A penetrating keratoplasty was performed 15 months after the initial DSAEK. Our second patient (case 2) was an 87-year-old female who underwent DSAEK for corneal edema secondary to Fuchs endothelial dystrophy in left eye. Six months later, she had an episode of graft rejection and developed secondary glaucoma. At 14 months postoperatively, a retrocorneal membrane was seen involving the temporal half of the endothelial surface of the graft. The retrocorneal membrane extended from the inferior thickened edge of the endothelial keratoplasty graft to the iris stromal surface. An Ahmed shunt implantation followed by repeat DSAEK were then performed. The excised corneal buttons were examined. RESULTS:: Histopathologic evaluation showed multilayered epithelium on the interface and attenuated endothelium in the endothelial graft in case 1. The host cornea showed diffuse stromal scarring. Case 2 showed multilayered epithelium with early cyst formation at the edge of the graft. The epithelium extended to involve the endothelial surface without involvement of interface surface. Significant scar formation was observed between the edge of the endothelial keratoplasty graft and thickened host Descemet membrane. Some pigmented cells were present within the epithelial downgrowth. The epithelium stained positively with cytokeratin A1/A3 in both cases. CONCLUSIONS:: Although rare, epithelial downgrowth can occur after DSAEK and can be associated with graft failure. Early recognition and surgical treatment of epithelial downgrowth is crucial in treating the complications of corneal decompensation and glaucoma.

Burns. 2009 Jun 6; Wang TH, Ma H, Yeh FL, Lin JT, Shen BHTo evaluate the effect of a new dressing method for clean wound coverage, two kinds of dressing materials are combined together to cover nine wounds in nine patients. All the wounds are split-thickness skin graft donor sites located in the anterior thighs. The size of the wounds ranges from 6cmx4cm to 10cmx8cm (42cm(2) on average). A central fenestration is created in the polyurethane film layer for draining the wound discharge, and a piece of 2.5cmx2.5cm carboxymethyl cellulose dressing is fixed on top of the fenestration for protecting the underlying wound. Dry gauze is used to cover the composite dressing, which is replaced daily. The wound condition is checked and recorded everyday until the patient is discharged. Further management and follow-up for the wound is performed at the outpatient department or by telephone. All wounds healed smoothly on the postoperative 6th to 7th day. No wound infection was noted, including one patient who had diabetes mellitus. Five patients responded to follow-up for at least 5 months and no hypertrophy scar formation was noted. From clinical experiences, we know that this new method is practical and cost-effective for covering small-sized, split-thickness skin graft donor-site wounds.

J Plast Reconstr Aesthet Surg. 2009 Jun 6; Qian JG, Wang XJPatients with osmidrosis are particularly concerned with malodour elimination after surgery. Open excision of the subcutaneous apocrine glands through a small incision seems to be the most logical and effective method available for osmidrosis. However, literature on long-term results and complications after such surgery based on large case series are rare. From January 2005 to May 2008, 256 consecutive patients with axillary osmidrosis were treated with our subcutaneous glands excision technique, of which 206 could be followed up from 3 to 40 (mean 18.1) months. Patients ranged in age from 14 to 52 (mean 23.4) years and the female to male ratio was 131:75. Among the 206 cases, 183 cases had family histories of the disease and 16 were accompanied with axillary hyperhidrosis. Postoperatively, as high as 97% of the patients achieved good results in terms of malodour elimination during the follow-up period. All patients reported reduction in axillary sweating; among them 16 patients complicated with axillary hyperhidrosis reported a significant reduction. Axillary hair growth was much reduced in most (95%) patients, and four female patients complicated with axillary hirsutism were extremely satisfied with axillary hair reduction. Early postoperative complications included haematoma (0.7%), seroma (1.2%), folding of skin flap (0.7%), pressure blister (3.6%), contact dermatitis (1%), superficial epidermis necrosis (37%), small granuloma (0.5%), wound infection (0.7%) and wound dehiscence (5.1%). Late complications included comedones (1.2%), milia (0.5%), sebaceous cyst (or with abscess) (0.7%), hypertrophic scar (1%), temporary skin pigmentation (0.5%), temporary mild lactation (0.5%) and temporary sweating outside the axillae (1%). In general, 196 patients (95%) were totally satisfied with the procedure and nine (4.4%) patients partially satisfied, with only one (0.5%) regretful. The procedure has a very high success rate with minor complications. It should become the preferred procedure for the surgical treatment of axillary osmidrosis.

J Burn Care Res. 2009 Jun 5; Richard RL, Lester ME, Miller SF, Bailey JK, Hedman TL, Dewey WS, Greer M, Renz EM, Wolf SE, Blackbourne LHThe development of burn scar contractures is due in part to the replacement of naturally pliable skin with an inadequate quantity and quality of extensible scar tissue. Predilected skin surface areas associated with limb range of motion (ROM) have a tendency to develop burn scar contractures that prevent full joint ROM leading to deformity, impairment, and disability. Previous study has documented forearm skin movement associated with wrist extension. The purpose of this study was to expand the identification of skin movement associated with ROM to all joint surface areas that have a tendency to develop burn scar contractures. Twenty male subjects without burns had anthropometric measurements recorded and skin marks placed on their torsos and dominant extremities. Each subject performed ranges of motion of nine common burn scar contracture sites with the markers photographed at the beginning and end of motion. The area of skin movement associated with joint ROM was recorded, normalized, and quantified as a percentage of total area. On average, subjects recruited 83% of available skin from a prescribed area to complete movement across all joints of interest (range, 18-100%). Recruitment of skin during wrist flexion demonstrated the greatest amount of variability between subjects, whereas recruitment of skin during knee extension demonstrated the most consistency. No association of skin movement was found related to percent body fat or body mass index. Skin recruitment was positively correlated with joint ROM. Fields of skin associated with normal ROM were identified and subsequently labeled as cutaneous functional units. The amount of skin involved in joint movement extended far beyond the immediate proximity of the joint skin creases themselves. This information may impact the design of rehabilitation programs for patients with severe burns.