Acne Scars

Plast Reconstr Surg. 2009 Jul; 124(1): 256-65Young VL, Hutchison JBACKGROUND: Few data are available regarding the psychological impact of scars arising from routine elective/aesthetic surgical procedures. To gain insight into both patients' and clinicians' concerns, the authors have undertaken structured semiquantitative surveys of (1) patients who had recently undergone a routine surgical procedure and (2) a cohort of plastic and aesthetic dermatological surgeons. METHODS: All selected patients had undergone a surgical procedure within 6 to 24 months before survey and had a scar(s) that caused concern. Participants completed a previously validated Self Completion Form that aimed to investigate their concerns. Clinicians were surveyed via telephone interviews using a similar format of questionnaire but with questions tailored to clinicians. RESULTS: Ninety-seven patients and 24 clinicians were interviewed. Patients were dissatisfied with scars resulting from surgery, irrespective of gender, age, ethnicity, or geographical location, and 91 percent would value even small improvements in scarring. Patients had scar(s) that they wished were less noticeable over a wide range of body sites (both "visible" and "nonvisible"). Male and female respondents had similar rates of dissatisfaction about their own scars. The survey revealed issues in the communication between patients and clinicians regarding scars; 71 percent of patients felt that they were more concerned than their surgeon about the scar resulting from a recent surgical procedure. CONCLUSIONS: This preliminary study indicates that patients are highly concerned about scarring following routine surgery, with most patients valuing any improvement in scarring. These data also show that there are disparities in patient-clinician communication regarding expectations following surgery.

Ultrasound Obstet Gynecol. 2009 Jun 29; 34(1): 80-84Hasegawa J, Matsuoka R, Ichizuka K, Mimura T, Sekizawa A, Farina A, Okai TOBJECTIVES: To investigate whether maternal history and ultrasound findings can be predictors for massive hemorrhage during Cesarean section in patients with placenta previa and adherence of the placenta. METHODS: We reviewed 127 singleton pregnancies with placenta previa. Maternal history, antenatal ultrasound findings of the placenta, including location, presence of placental lacunae, lack of a clear zone, presence of sponge-like findings of the cervix and presence of a marginal sinus in cases of placenta previa were reviewed retrospectively, and their association with amount of bleeding during Cesarean section was analyzed. RESULTS: Logistic regression analysis revealed that advan-ced maternal age (odds ratio (OR), 5.4; 95% CI, 1.8-16.4), previous Cesarean section (OR, 20.4; 95% CI, 4.0-105.2) and sponge-like findings in the cervix (OR, 5.6; 95% CI, 1.8-17.0) were associated with massive bleeding (> 2500 mL). Placental adherence occurred in five cases and was more frequent in cases where the placenta was located at the site of the scar of a previous Cesarean section (OR, 123.1; 95% CI, 4.5-3395.2) and where there was lack of a clear zone (OR, 48.0; 95% CI, 3.8-604.7). CONCLUSIONS: Advanced maternal age, previous Cesarean section and presence of sponge-like findings in the cervix are risk factors for massive bleeding during Cesarean section in cases of placenta previa, regardless of whether placental adherence is present. Placental location on the scar of a previous Cesarean section and lack of a clear zone are risk factors for placental adherence. When these findings are identified preoperatively, management should be tailored accordingly. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.

Zhonghua Zheng Xing Wai Ke Za Zhi. 2009 Mar; 25(2): 81-4Yin NB, Zhao M, Huang JJ, Zhao ZM, Xiong B, Liu ZJ, He YL, Cheng T, Zhang COBJECTIVE: To develop a new method for reparation of cleft lip, and to evoke more colleagues for advance practices and study, in order to determine her indication and contraindication as soon as possible. METHODS: 48 cases were included into this study. Trilobate flap were designed in floor of nose and lip area in cleft side, rotate two of the three flaps upwards, respectively to elevate the tip of nose, and to reconstruct the floor of nose. As for the left flap, it was drived transversally to opposing side, sutured with the flap of non-cleft-side. RESULTS: With this technique, less tissue was lost, better vertical lengthening and good formed cupids-bow was achieved, and the scar was a parallel line being symmetry to the philtrum column opposide. Meanwhile, because the tension was mainly located in the area where there was no mini flaps, the blood supply was good enough, rarely occur any necrosis in the tip of flaps. All cases in this study obtained perfect healing, with good appearance at nostrils and floor of nose. CONCLUSIONS: In use of the method of trilobate flap, we can draw down the peak of the cupids bow effectually, hence avoid the addition cut in the lower part of the lip, decrease the scar on skin, as well as nice reconstruction of floor of nose, philtrum column and nostril. Because lack of long term study, we evoke more colleagues for cooperation in advance study.

Ultrasound Obstet Gynecol. 2009 Jun 29; 34(1): 85-89Wang CB, Chiu WW, Lee CY, Sun YL, Lin YH, Tseng CJOBJECTIVES: To determine the prevalence of clinical symptoms associated with Cesarean scar defects, and to determine the association between the size of these defects, clinical complaints, uterine position, and a history of multiple Cesarean sections. METHODS: In this cross-sectional study, Cesarean scar defects in women with a history of transverse lower-segment Cesarean section were measured by transvaginal ultrasound while being assessed for other gynecological conditions. The relationships between the size of the Cesarean scar defect and the clinical symptoms, uterine position and number of previous Cesarean sections were evaluated. Patients with other uterine pathologies, including endometrial hyperplasia, polyps, malignancy and submucosal myomas, were excluded from the study. RESULTS: During a 3-year period, 4250 women were assessed by transvaginal sonography, of whom 293 (6.9%) were diagnosed with Cesarean scar defects. Eighty-six patients were excluded due to other uterine pathologies. Altogether, 207 patients with Cesarean scar defects were included in this study. Women who had undergone multiple Cesarean sections tended to have larger scar defects (in width and depth) than did those who had undergone a single Cesarean section. Women with retroflexed uteri also tended to have wider defects than those with anteflexed uteri. Defect width was significantly greater in women with postmenstrual spotting, dysmenorrhea and chronic pelvic pain. CONCLUSIONS: Multiple Cesarean sections and retroflexed uteri are risk factors for larger Cesarean scar defects. The size of the Cesarean scar defect is associated with clinical symptoms such as postmenstrual spotting, dysmenorrhea and chronic pelvic pain. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.