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There has been a long-standing need for guidelines on the diagnosis and treatment of keloids and hypertrophic scars that are based on an understanding of the pathomechanisms that underlie these skin fibrotic diseases. This is particularly true for clinicians who deal with Asian and African patients because these ethnicities are highly prone to these diseases. By contrast, Caucasians are less likely to develop keloids and hypertrophic scars, and if they do, the scars tend not to be severe. This ethnic disparity also means that countries vary in terms of their differential diagnostic algorithms. The lack of clear treatment guidelines also means that primary care physicians are currently applying a hotchpotch of treatments, with uneven outcomes. To overcome these issues, the Japan Scar Workshop (JSW) has created a tool that allows clinicians to objectively diagnose and distinguish between keloids, hypertrophic scars, and mature scars. This tool is called the JSW Scar Scale (JSS) and it involves scoring the risk factors of the individual patients and the affected areas. The tool is simple and easy to use. As a result, even physicians who are not accustomed to keloids and hypertrophic scars can easily diagnose them and judge their severity. The JSW has also established a committee that, in cooperation with outside experts in various fields, has prepared a Consensus Document on keloid and hypertrophic scar treatment guidelines. These guidelines are simple and will allow even inexperienced clinicians to choose the most appropriate treatment strategy. The Consensus Document is provided in this article. It describes (1) the diagnostic algorithm for pathological scars and how to differentiate them from clinically similar benign and malignant tumors, (2) the general treatment algorithms for keloids and hypertrophic scars at different medical facilities, (3) the rationale behind each treatment for keloids and hypertrophic scars, and (4) the body site-specific treatment protocols for these scars. We believe that this Consensus Document will be helpful for physicians from all over the world who treat keloids and hypertrophic scars.

Summary Background We experienced the occurrence of breast deformity in some young female patients who underwent a modified Nuss procedure before breast development. We studied the causes of and preventive measures for this complication. Methods We classified 13 prepubescent female patients who underwent our modified Nuss procedure into three groups according to the direction of the skin incision and the dissection layer for bar insertion. Four patients who underwent transverse lateral thoracic skin incision and bar insertion through a subpectoral dissection were assigned to the T/SP group, five who underwent oblique skin incision along the rib and bar insertion through a suprapectoral dissection were assigned to the O/IP group, and four who underwent oblique skin incision and subpectoral dissection were assigned to the O/SP group. Each patient in the T/SP group underwent the operation by a different surgeon, two of whom were the authors, including the first author; the first author performed all operations in the O/IP and O/SP groups. The first author evaluated the shape of the developed breasts using the frontal- and oblique-view photographs. We also investigated the location of the lateral border of the mammary gland in seven other adolescent and adult female patients using three-dimensional computed tomography images. Results Lateral depression of the breast occurred in four of eight breasts with a transverse incision, and flattening of the lowermost portion of the inframammary fold occurred in six of 10 breasts with suprapectoral dissection. None of the eight breasts with an oblique incision and subpectoral dissection exhibited deformities. The lateral border of the mammary gland was on the fifth rib in five patients and on the fifth intercostal space in two patients. Conclusion An oblique lateral thoracic skin incision along the sixth rib and subpectoral dissection may reduce the occurrence of breast deformity.

Vascular malformations of bone are complex lesions that can cause deformity and pain. A combined soft tissue and intraosseous venous malformation of the left thumb in a girl was treated with two sessions of ethanol sclerotherapy using a bone marrow aspiration needle under fluoroscopic guidance.

Venous malformations (VM) of lower extremities have characteristic symptoms, especially swelling, pain at rest or with dependence, or in the morning, or with exertion. Sclerotherapy has been applied and has been showed to alleviate the associated signs and symptoms. The aim of this study is to evaluate the outcomes of ethanol sclerotherapy for VM of lower extremities. The 21 patients of intramuscular VM of the lower extremities, who received percutaneous sclerotherapy using absolute ethanol in our institute, were reviewed retrospectively. The average age at the time of the initial diagnosis was 18.6 years, and average follow-up period after last sclerotherapy is 19.4 ± 13.5 months. The postinterventional changes of the associated signs and symptoms were evaluated by utilizing original VM scoring system. The average number of sclerotherapy sessions was 2.6 times per case. The average total amount of ethanol used in each patient was 41.3 ml. Sclerotherapy reduced the associated signs and symptoms in many of the patients (n = 19/21). Preinterventional VM score as the overall baseline status was 10, and the average VM score after sclerotherapy was 4.1. There was no inverse correlation between the amount of ethanol used and the VM score. In seven cases treated more than three times, reverse correlation between the “VM score” and the number of sclerotherapy sessions was demonstrated (p

BACKGROUND It has recently been demonstrated that near-infrared (NIR) fluorescence imaging can be usedto visualize the blood vasculature. Although sclerotherapy has been successfully used in treating venousmalformations, the spread of sclerosant is difficult to monitor during sclerotherapy.OBJECTIVE To evaluate the safety and efficacy of NIR fluorescence imaging in percutaneous sclerotherapyof soft-tissue venous malformations.METHODS AND MATERIALS The use of NIR fluorescence imaging after administration of indocyanine green(ICG) was evaluated in duplex-guided sclerotherapy performed on 15 patients with venous malformations.The lower extremities were involved in seven, the upper extremities in four, and the face in four.RESULTS In 13 of the 15 procedures, spotty fluorescence images were obtained, and in eight procedures,linear fluorescence images were obtained. In two patients with intramuscular venous malformations in thelower extremities, no fluorescence images were obtained. Observational depth seemed to be

BACKGROUND Sclerosants are used to treat vascular malformations. Owing to variations in the flow, the injected concentrations and the duration of exposure of these sclerosants are altered. Therefore, the clinical effectiveness of sclerotherapy is variable. OBJECTIVE The objective was to evaluate the differences in clinical response, usually observed among ethanol, polidocanol, and OK-432, using an in vitro sclerotherapy model. METHODS Endothelial cells were cultured and exposed to different concentrations of the sclerosants for 5 seconds and the remaining viable cells were counted using a MTT assay kit. Dyes were used to visualize the morphologic changes. Precipitant formation in blood was also evaluated. Finally, the degree of ICAM-1 expression, after exposure to lower concentrations of these sclerosants, was studied using immunocytochemistry. RESULTS Only ethanol causes precipitant formation and kills almost all cells from 30% concentration. Polidocanol begins to disrupt the cell membrane from 0.0125% onward. Only OK-432 induces ICAM-1 expression. CONCLUSION Ethanol's strong precipitant-forming effect may induce thromboembolism, thus enhancing sclerosis. Polidocanol's endothelial cell-lysing effect was clearly documented. OK-432 may mediate its effect by inducing inflammatory response of the endothelium via ICAM-1 expression. This in vitro model may be useful in evaluating other sclerosants as well.