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To compare the clinical and radiologic outcomes and arthroscopic findings of proximal tibial osteotomy (PTO) alone versus PTO combined with medial meniscal posterior root repair (MMPRR).Between October 2010 and September 2016, patients who underwent PTO and second-look arthroscopy at a minimum of 24 months postoperatively were reviewed. Patients were divided into group I (isolated PTO), group P (PTO with MMPRR using the pull-out technique), and group F (PTO and MMPRR using the side-to-side repair method). The subjective knee scores were assessed. Radiologic evaluation was based on the Kellgren-Lawrence grade. Healing of medial meniscal posterior root tears (good/loose/scar tissue/failed) and cartilage regeneration (excellent/good/poor) were assessed by arthroscopic examination.Mean clinical follow-up duration of group I (n = 22), P (n = 25), and F (n = 24) was 28.5 ± 5.7, 27.9 ± 6.2, and 26.3 ± 5.3 months, respectively. At final follow-up, Lysholm score, International Knee Documentation Committee subjective score, and Tegner activity scale significantly improved in all groups (P.001), and subjective scores did not differ among the groups. The Kellgren-Lawrence grade progression showed no significant differences among 3 groups (P = .461). Good healing of medial meniscal posterior root tears was found in 24% and 12.5% of patients in groups P and F, respectively, and 0 in group I; there were significant differences between groups I and P (P.001) and groups I and F (P.001). Excellent cartilage regeneration in the medial femoral condyle and medial tibial plateau was found in 13.6% and 9.1% in group I, 24% and 12% in group P, and 16.7% and 8.3% in group F, respectively, without significant differences.Concurrent MMPRR during PTO appears to improve the arthroscopic appearance (healing of MMRPTs and cartilage regeneration) during second-look arthroscopy. However, concurrent MMPRR does not significantly improve clinical and radiologic outcomes at short-term follow-up.Level III, retrospective comparative study.

Introduction: Phonomicrolaryngeal surgery involves the surgical treatment of benign disorders of the vocal folds. Postoperative scar tissue in vocal fold mucosa is undesired because mucosal hypodynamia may lead to prolonged impairment in voice quality. This study aims to present and share the outcomes of a new endolaryngeal suture technique. Methods: This study consists of patients who underwent vocal fold surgery followed by endolaryngeal microscopic suturation with a technique that we call the “mini-microsuture technique” between January 2018-December 2019. Videolaryngoscopic images were examined to observe the tissue healing process (suture elimination time, mucosal scar status, and wave pattern) at the first and the fourth week postoperatively. Results: A retrospective analysis was made in 144 (57 males (39.5%) and 87 females (60.5%)) patients who underwent phonomicrosurgery with “Mini-microsuture technique.” Mean age was 40.61 ± 13.54 (10-78) years. There were multiple pathological lesions in 41.66% (n: 60) of our patients, and 58.33% (n: 84) of them had single-lesion. 63.88% (n: 92) of the patients had bilateral vocal fold lesions where 36.22% (n: 52) of the patients had pathology in one vocal fold. Conclusions: The “mini-microsuture technique” is an easy and functional procedure that can be performed by a single surgeon under microscopy, which minimizes tissue trauma, prevents mucosal hypodynamia, and provides a better anatomical structure postoperatively for a symmetrical vibration. The technique does not significantly prolong operation time when mastered and is a cost-effective method in which surgery which can be concluded using a single suture material.

Scar tissues have been important factors in determining the progression of myocardial diseases and the development of adverse cardiac failure outcomes. Accurate segmentation of the scar tissues can be helpful to the clinicians for risk prediction and better evaluation of cardiovascular diseases. Our goal is to apply topology data analysis toward machine learning algorithms to confirm the geometry of scar tissue, in addition to gaining better visualization and quantification of the scar tissue present. We have introduced architecture for integrating geometry in the form of topology toward machine learning. Morphological image processing was carried out to define the regions of the endocardial wall. We implemented convolutional neural networks on delayed enhancement cardiac computed tomography images for the recognition of scar tissue. Segmented two-dimensional images were stacked up to build the geometry of the scar area for visualization purposes. Mathematical calculations were executed for the validation of the scar tissue in addition to performing morphological image processing and marking the scar tissue present on the endocardial wall of the left ventricular. We applied convolutional neural network over convolution and pooling the layers with small sizes; we achieved 89.23% accuracy, 91.11% sensitivity, and 87.75% specificity, and found the dissimilarity distance between the normal endocardial tissue distances to be 9.37. This new concept in this study contributes toward a better understanding of scar structure and transmural variation of the endocardial wall of the left ventricular.

The aim of research is to study morphofunctional reorganization of the oral mucosa during regeneration of a wound defect using polymer membranes based on a copolymer of vinylidene fluoride with and without tetrafluoroethylene. Material and methods. The study included 35 white Wistar rats weighed 220–280 g. All animals were divided into three groups: group 1 – intact animals, group 2 – an experimental comparison group, and group 3 – an experimental main group. A wound defect in rats was formed by the excision of the mucosal flap in rats; this defect was overlapped by a polymer membrane in animals of the 3rd group. Histological and macroscopic studies were performed in 3, 7 and 12 days. Results. More rapid development of the granulated and loose fibrous connective tissue noted already on the 3rd day of the study was recorded in animals of the 3rd group. On the 7th day of the study a 1.5-time decrease in inflammatory infiltrate was recorded in animals of the experimental main group, while in the experimental comparison this indicator decreased in only 1.35 times. Moreover, the formation of the loose fibrous connective tissue in the main experimental group occurred 3.2 times more intensively than in the comparison group. On the 12th day, the specific area of the loose fibrous connective tissue in the experimental main group was 1.4 times larger, and the specific area of scar tissue was 3 times smaller than in the experimental comparison group. Conclusion. Application of polymer membrane demonstrated a decrease in inflammatory infiltrate and more rapid maturation of the loose fibrous connective tissue compared with the open wound management. Moreover, there was a significantly smaller formation of the dense fibrous connective tissue. Thus, it is possible to conclude on the effectiveness of polymer piezoelectric membrane application in the management of oral wound.

Revision hammertoe surgery can be extremely challenging for the foot and ankle surgeon given the scar tissue and available osseous and soft tissue. Although not a common procedure, lesser metatarsophalangeal joint arthrodesis is an option for the patient especially in lieu of an amputation. This article describes the current literature and the surgical technique for a lesser metatarsophalangeal joint arthrodesis.

Scalp reconstruction is challenging because the scalp is inelastic, stiff, and has hair follicles. Tissue expansion offers aesthetically pleasing outcomes with minimal donor-site morbidity. However, in a scarred scalp, the extent of possible dissection for the expander insertion may be limited and surgeons must make use of the limited scalp tissue. We successfully reconstructed scarred scalps using rectangular expanders. This report presents two cases: a 4× 3 cm chronic defect with widespread scarring and osteomyelitis and an 11× 7.5 cm scar tissue following a skin graft. Tissue expanders were inserted in the subgaleal plane and were inflated by 195 mL and 400 mL over periods of 2 and 3 months, respectively. Subgaleal elevation of a fasciocutaneous flap was achieved with the expanded tissue. The defects were well covered, with good color, texture, and hair-bearing tissue. There were no complications involving the tissue expanders. Rectangular expanders yield more available tissue than round or crescent-shaped expanders. Moreover, since the base of the flap is well defined, the expander can be easily inserted in a limited space. Therefore, rectangular expanders are recommended for the reconstruction of scarred scalps.

Keloids are benign fibroproliferative growth seen on the skin usually secondary to trauma. They are scar tissues that project above the skin surface and may be tender or pruritic. They cause functional and aesthetic discomfort to the patient. This is a case report of a 34 year old woman who was diagnosed as a case of keloid of the left auricle and treated surgically. Keloids have a high degree of recurrence even after treatment. It is crucial to differentiate keloids from hypertrophic scars and treat them accordingly.

Corporal fibrosis is a process that involves excessive deposition of scar tissue in response to infection, trauma, or ischemia. It does not occur merely as a result of previous IPP surgery. Excessive development of corporal fibrosis is certain after extraneous and disastrous events such as priapism or the removal of a device for infection. The usual surgical planes and spaces are obliterated by proliferation of scar both in the tissues overlying the corpora and the space within the corpora previously occupied by erectile tissue. To maximize success, specialized instruments, downsized cylinders, and lots of experience are necessities. Prosthetic urology produces, for the most part, happy patients. Fibrosis guys, to a man are not happy. Let the expert have the unhappy patient!

The present study evaluated the effect of fucoidan/alginate-polyethylene glycol-gellan gum (Fu/AL-PEG@GGH) hydrogel using low-level laser therapy (LLLT) on facilitating wound healing for wound care management. The hydrogel was fabricated and characterized to evaluate the wound healing potential. Cytotoxicity and apoptotic effects were evaluated with L929 and NIH3T3 cells. Uniform spherical sheets were observed with high thermal stability caused by porous matrixes with the increased cell viability and fast cell migration. Scar tissue was reduced by larger wound contraction with faster healing effects from the hydrogel + LLLT-treated group at day 14. The polysaccharides may promote wound healing due to the strong bonds by the physical cross-linking in hydrogel preparation. The results from hydrogel + LLLT-treated group confirmed an effective wound healing potential from the presence of high fibroblast and collagen deposition. Therefore, the combined practice of the hydrogel with LLLT may enhance a wound healing process for effective wound care applications.

Background: Image evaluation of scar tissue plays a significant role in the diagnosis of cardiovascular diseases. Segmentation of the scar tissue is the first step towards evaluating the morphology of the scar tissue. Then, with the use of CT images, the deep learning approach can be applied to identify possible scar tissue in the left ventricular endocardial wall. Objective: To develop an automated method for detecting the endocardial scar tissue in the left ventricular using Deep learning approach. Method: Pixel values of the endocardial wall for each image in the sequence were extracted. Morphological operations, including defining regions of the endocardial wall of the LV where scar tissue could predominate, were performed. Convolutional Neural Networks (CNN) is a deep learning application, which allowed choosing appropriate features from delayed enhancement cardiac CT images to distinguish between endocardial scar and healthy tissues of the LV by applying pixel value-based concepts. Result: We achieved 89.23% accuracy, 91.11% sensitivity, and 87.75% specificity in the detection of endocardial scars using the CNN-based method. Conclusion: Our findings reveal that the CNN-based method yielded robust accuracies in LV endocardial scar detection, which is currently the most extensively used pixel-based method of deep learning. This study provides a new direction for the assessment of scar tissue in imaging modalities and provides a potential avenue for clinical adaptations of these algorithms. Additionally this methodology, in comparison with those in the literature, provides specific advantages in its translational ability to clinical use.

Control of facial scarring is one of the most difficult challenges in surgical practice, and represents a difficult therapeutic problem facing plastic surgeons to achieve good results. To date, no gold standard exists for the treatment of scar tissue. Autologous fat grafting has been introduced as a promising treatment option for scar tissue related symptomsHowever, those experimental confirmation for its viability remains vague. With assess techniques, results of fat grafting Also its effects once enhancing the facial scars. This study might have been directed for 20 patients for clear facial scars. Patients‟ agdistis went starting with 8 to 60 A long time. Patients were chosen haphazardly will a chance to be dealt with for fat grafting. The abdomen might have been those practically usually decided contributor site. Fat might have been transformed with axis done 10 (group An) and natural in the different 10 cases (group b (. Fat grafting demonstrated should bring a critical part clinched alongside scar remodeling. This might have been measured clinically Toward those vancouver scar scale. In regards to tolerant fulfillment for cosmea appearance, 9 situations were assessed as excellent, 6 cases were assessed Likewise good, and 3 situations were assessed Similarly as reasonable Furthermore 2 were assessed Concerning illustration terrible. Autologous fat grafting need An critical part for facial scar remodeling Also gives An useful impact for facial scar tissue. Noteworthy change over scar appearance, skin characteristics, Also rebuilding of volume and three‑dimensional shape will be accounted. There may be no noteworthy Contrast between comes about from claiming both bunches.

Scar tissue formation after synovectomy limits range of motion and causes muscle atrophy. The functional results for patients who underwent total open knee synovectomy often included questionnaires, and assessment of muscle strength was lacking in the literature. Therefore, we aimed to identify the strength and range of motion outcomes for patients who underwent total open synovectomy and to compare the results with the contralateral limb and healthy individuals. Knee range of motion and muscle strength were assessed in fourteen patients that underwent total (anterior and posterior) open knee synovectomy and were compared with the contralateral limb and with 14 healthy individuals matched by sex, age, height, and weight. The range of motion of flexion decreased 8.4% compared with the contralateral limb (95% CI − 18.9 to − 4.7, p = 0.002) and 9.9% compared with the control group (95% CI 3.9–14.9, p

Objective: High-intensity laser therapy (HILT) combined with photobiomodulation therapy (PBMT) using a diode or CO2 laser was administered after extraction of the left first molar in rats. Effects on socket preservation (preservation of the alveolar bone and healing time after extraction) were evaluated histopathologically. Background: Irradiation using a diode or CO2 laser has been shown to hasten wound healing, but the effects remain controversial. Methods: Five-week-old male Wistar rats that underwent extraction of the left maxillary first molar were divided into three groups: diode laser irradiation (diode group), CO2 laser irradiation (CO2 group), and no laser irradiation (control group). HILT (27 J) was performed immediately after tooth extraction to enhance blood coagulation, followed by PBMT (0.7 J) 1 day later to enhance healing. Tissues, including the extraction socket, were removed en bloc 3, 5, 7, 10, and 21 days postextraction to determine the morphological characteristics of wound healing and the distribution of myofibroblasts involved in scar formation. Results: In the diode and CO2 groups, new bone formation and cancellous bone maturation were observed at an early stage of wound healing. The number of myofibroblasts was significantly lower in the laser treatment groups than the control (p

Fractional CO2 procedures are an established, safe and effective armamentarium for managing skin rejuvenation and scarring. Very short-pulse-duration devices offer a very high ablated volume/ablated surface ratio, inducing a controlled thermal damage. With this kind of device, each procedure can be customized on the features of the skin of each patient. The same device can be used to treat severe burn scars. With a very deep fractional procedure on a scar tissue, immediate relaxation of the tension and retraction forces may be obtained, and downstream, improvements are related more to the activation of a molecular cascade. The authors review the state-of-the-art, in the use of fractioned CO2 laser technology for aesthetic and scar remodelling indications.

Pulmonary fibrosis involves the formation of inappropriate scar tissue in the lungs, but what drives fibrosis is unclear. Sialidases (also called neuraminidases) cleave terminal sialic acids from glycoconjugates. In humans and mice, pulmonary fibrosis is associated with desialylation of glycoconjugates and upregulation of sialidases. Of the four mammalian sialidases, we previously detected only NEU3 in the bronchoalveolar lavage fluid from mice with bleomycin-induced pulmonary fibrosis. In this report, we show that NEU3 upregulates extracellular accumulation of the profibrotic cytokines IL-6 and IL-1β, and IL-6 upregulates NEU3 in human peripheral blood mononuclear cells, suggesting that NEU3 may be part of a positive feedback loop potentiating fibrosis. To further elucidate the role of NEU3 in fibrosis, we used bleomycin to induce lung fibrosis in wild-type C57BL/6 and Neu3−/− mice. At 21 days after bleomycin, compared with male and female C57BL/6 mice, male and female Neu3−/− mice had significantly less inflammation, less upregulation of other sialidases and the profibrotic cytokine active transforming growth factor β1, and less fibrosis in the lungs. Our results suggest that NEU3 participates in fibrosis and that NEU3 could be a target to develop treatments for fibrosis.

Background: Median arcuate ligament (MAL) syndrome is a rare cause of chronic abdominal pain in adults and children. Release of the MAL has traditionally been performed open or laparoscopically. There have not been any published cases to our knowledge of robotic-assisted MAL release in pediatric patients. Patients and Methods: Two adolescent patients, aged 12 and 15 years, at our institution underwent robotic-assisted MAL release. The procedure involved dissecting the MAL muscle fibers and overlying scar tissue. Patients stayed inpatient postoperatively overnight and with an average outpatient follow-up of 10 months. Results: Both patients had immediate pain relief postoperatively and at 10-month follow-up had no recurrent symptoms. No complications were associated with the procedure. Conclusion: The increasing role of robotic surgery as a new surgical technique is gaining momentum for many procedures. This new approach for MAL release in the pediatric population was explored by our institution. It was found to be successful, safe, and reproducible for future patients.

Objective: based on the analysis of literary sources, to justify the feasibility of using collagen-based biopolymer films for dura mater, to analyze experimentally the ability of this material to biodegrade and form a new dura mater using light optical microscopy and IR spectroscopy, and to investigate the possibility of application of biopolymer collagen-based films as a substitute for the dura mater. Materials and methods. Thirteen rats weighing 200–250 g under general anesthesia were operated. Craniotomies were performed. The dura mater was incised crosswise from the middle to its corners. The surface of the cerebral cortex was exposed and was penetrated with a G18 needle to a depth of 2 mm. Dura mater flaps were not sutured with diastasis between the edges. A small piece of collagen film was placed over dissected dura and the bone flap was removed. The basic group consisted of 10 animals and the control group without collagen film included 3 animals. Three weeks after the intervention, all animals were euthanized and operating sites, including skull and cortical tissue, were explanted for histological, macroscopic examination and molecular analysis by infrared spectroscopy. Results. According to the results of macroscopic and histological examination, collagen substitute for the dura mater does not lead to severe inflammatory complications and excessive scar adhesions, prevents cerebrospinal fluid outflow, is capable of biodegradation with the replacement of connective tissue resembling a newly formed dura mater. Conclusions. 1. The experiment confirmed the ability of collagen-based films to biodegrade in 3 weeks after penetration trauma in rats. 2. The data of both infrared spectroscopy and morphological study indicate that at the border of the collagen implant and the native dura mater the regeneration processes prevail over the formation of scar tissue. 3. The data obtained confirm the collagen-based substitute to be used for dura mater plastics.

Checkrein deformity is characterized by flexible plantar flexion contracture of the interphalangeal joint and flexible extension contracture of the metatarsophalangeal joint of the hallux. It occurs due to entrapment of the flexor hallucis longus in the callus formation at the fracture site or within scar tissue on lower limb. Currently, there is still no consensus about the best surgical treatment for this deformity. The aim of this study is to report a case of a patient that was treated with a novel approach for the treatment of checkrein deformity of the hallux located in the forefoot, with satisfactory functional outcomes. Level of Evidence V; Therapeutics Studies; Expert Opinion.

Background The scalpel was once the gold standard for surgical incisions. Electrosurgery has started to supplant scalpels but is not yet acceptable for skin incisions due to the risk of burns and deeper injury relative to the scalpels' neat incision with less tissue damage. The unnecessary burden of excessive scar formation makes comparing these two methods challenging. Therefore, this study aims to compare post-incision skin scarring created after monopolar electrosurgery and scalpel surgery, and evaluate the Patient and Observer Scar Assessment Scale (POSAS) suitability for assessing skin incision scars by comparing patients' and observers’ scores. Methods This self-controlled study involved patients undergoing elective and emergency skin surgery procedures. A singular wound site was created using two incision methods (monopolar electrosurgery and scalpel) simultaneously. Post-incision scar tissue formation was evaluated using the POSAS, a subjective scar assessment tool that involved patients self-reporting on pain, itching, color, thickness flexibility, and surface relief. Observer-rated vascularity, pigmentation, thickness, flexibility, and surface relief both using a 5-point Likert-type scale. We performed this assessment three months post-surgery, and the results were analyzed by a battery of statistical tests and linear mixed models. Results Twenty patients were included in this study. Data analyzed using the paired t-test or Wilcoxon rank-sum test indicated no statistically significant differences between the scar tissue created by monopolar electrosurgery and scalpels according to both the patients and the observers. Correlation analyses between the patients' and observers’ total POSAS scores indicated these followed a moderate linear relationship (r = 0.51; p, Highlights • The scalpel was once the gold standard for surgical incisions. • Electrosurgery has started to supplant scalpels but is not yet acceptable for skin incisions due to the risk of burns. • The Patient and Observer Scar Assessment Scale (POSAS) is a subjective scar assessment. • Our results show that electrosurgery was not inferior to the scalpel technique. • The POSAS instrument is an acceptable means of assessing scar formation on the skin.

The definition of a cesarean scar pregnancy (CSP) is the localization of the gestational sac (GS) in the cicatrix tissue, which is created in the front wall of the uterus after a previous cesarean section (CS). The worldwide prevalence of CSP has been growing rapidly. However, there are no general recommendations regarding prophylaxis and treatment of the abnormalities of the anterior wall of the uterus discovered in a non-pregnant myometrium, or how to deal with existing cases of CSP. We present the latest knowledge, a holistic approach to the biology, histology, imaging, and management concerning post-CS scars based on our cases, which were treated in the Department of Pregnancy and Pathology of Pregnancy in the Medical University of Lublin, Poland. In our study, we present images of tissue samples of areas with a cicatrix in the uterus, and ultrasound and MRI images of CSP. We discuss the advances in the biology of the post-CS scar tissue, the prevention techniques used to repair the scar defect (niche) before the pregnancy, and the treatment of different complications of CSP, such as the rupture of the gravid uterus or the dehiscence of the myometrium.

Background. The treatment of cicatricial deformities of the periorbital region is one of the most difficult problems of ophthalmoplasty. The choice of treatment tactics depends on the correct assessment of the type of periorbital scarring, which further determines its effectiveness. Based on the analysis of literature sources, the causes of periorbital scarring are determined, and modern me­thods of their clinical assessment and treatment are presented. The purpose: to analyze the current state of the issues of pathogenesis, classification, diagnosis, and treatment of post-traumatic cicatricial deformities of the periorbital region. Materials and methods. The research was carried out using the search and information systems PubMed, eLibrary, Google Scholar, and library databases for the period 2012–2020. Results. It was found that the formation and type of scars depend on many internal and external factors. The most common classification divides the scars into normotrophic, atrophic, hypotrophic, which refer to superficial scars, as well as deep — hypertrophic, keloid, and mixed. Determining the stages of scar tissue formation is important for choosing a method of treating a patient and obtaining the most positive result. Various thoughts are given regar­ding the stages and timing of the wound healing and scar formation process. The main modern methods of assessing and diagnosing scars have been determined, their advantages and disadvantages have been analyzed. The modern approaches to the treatment of scars based on their type were analyzed. Conclusions. The results of the analysis of modern literary sources showed that the issue of the etiology and pathogenesis of pathological scars has not yet been finally resolved. There is no single approach to diagnosis and treatment of scars, the optimal timing of treatment initiation. A particular problem is the treatment of cicatricial deformities of the periorbital region, which is predetermined by its anatomical and functional complexity. All this makes the task of studying the features of the course of scar formation of this particular area and the development of individualized algorithms for their treatment urgent., Актуальність. Лікування рубцевих деформацій періорбітальної ділянки є однією із найбільш складних проблем офтальмопластики. Від правильної оцінки типу рубцювання залежить вибір тактики лікування, що в подальшому визначає його ефективність. На основі аналізу літературних джерел визначено причини виникнення рубців періорбітальної ділянки, наведено сучасні методи їх клінічної оцінки та лікування. Метою роботи був аналіз сучасного стану питань патогенезу, класифікації, діагностики та лікування посттравматичних рубцевих деформацій періорбітальної ділянки. Матеріали та методи. Дослідження проведено з використанням пошуково-інформаційних систем PubMed, eLibrary, Google Scolar та бібліотечних баз даних за період 2012–2020 рр. Результати. Встановлено, що утворення та тип рубців залежать від багатьох внутрішніх і зовнішніх факторів. За найбільш поширеною класифікацією рубці поділяються на нормотрофічні, атрофічні, гіпотрофічні, які відносяться до поверхневих рубців, а також глибокі — гіпертрофічні, келоїдні та змішані. Визначення етапів формування рубцевої тканини є важливим для вибору методу лікування хворого та отримання максимально можливого позитивного результату. Наведено різні думки щодо етапів та термінів процесу загоєння рани та формування рубців. Визначено основні сучасні методи оцінювання та діагностики рубців, проаналізовано їх переваги та недоліки. Проаналізовано сучасні підходи до лікування рубців, зважаючи на їх тип. Висновки. На основі проведеного аналізу сучасних літературних джерел можна зазначити, що питання етіології і патогенезу патологічних рубців дотепер остаточно не вирішено. Не існує єдиного підходу до діагностики та лікування рубців, оптимальних термінів початку лікування. Особливу проблему становить лікування рубцевих деформацій періорбітальної ділянки, що зумовлено її анатомо-функціональною складністю. Все це робить актуальним вивчення особливостей перебігу формування рубців саме цієї ділянки та розроблення індивідуалізованих алгоритмів їх лікування.

Contrast-enhanced cardiac magnetic resonance imaging (MRI) is routinely used to determine myocardial scar burden and make therapeutic decisions for coronary revascularization. Currently, there are no optimized deep-learning algorithms for the automated classification of scarred vs. normal myocardium. We report a modified Generative Adversarial Network (GAN) augmentation method to improve the binary classification of myocardial scar using both pre-clinical and clinical approaches. For the initial training of the MobileNetV2 platform, we used the images generated from a high-field (9.4T) cardiac MRI of a mouse model of acute myocardial infarction (MI). Once the system showed 100% accuracy for the classification of acute MI in mice, we tested the translational significance of this approach in 91 patients with an ischemic myocardial scar, and 31 control subjects without evidence of myocardial scarring. To obtain a comparable augmentation dataset, we rotated scar images 8-times and control images 72-times, generating a total of 6,684 scar images and 7,451 control images. In humans, the use of Progressive Growing GAN (PGGAN)-based augmentation showed 93% classification accuracy, which is far superior to conventional automated modules. The use of other attention modules in our CNN further improved the classification accuracy by up to 5%. These data are of high translational significance and warrant larger multicenter studies in the future to validate the clinical implications.

There is a critical need for interventions to control the development and remodeling of scar tissue after myocardial infarction. A significant hurdle to fibrosis-related therapy is presented by the complex spatial needs of the infarcted ventricle, namely that collagenous buildup is beneficial in the ischemic zone but detrimental in the border and remote zones. As a new, alternative approach, we present a case to develop self-adapting, mechano-sensitive drug targets in order to leverage local, microenvironmental mechanics to modulate a therapy's pharmacologic effect. Such approaches could provide self-tuning control to either promote fibrosis or reduce fibrosis only when and where it is beneficial to do so.

A certain cell type can be isolated from different organs in the adult body that can differentiate into ectoderm, mesoderm, and endoderm, providing significant support for the existence of a certain type of small, vascular-associated, pluripotent stem cell ubiquitously distributed in all organs in the adult body (vaPS cells). These vaPS cells fundamentally differ from embryonic stem cells and induced pluripotent stem cells in that the latter possess the necessary genetic guidance that makes them intrinsically pluripotent. In contrast, vaPS cells do not have this intrinsic genetic guidance, but are able to differentiate into somatic cells of all three lineages under guidance of the microenvironment they are located in, independent from the original tissue or organ where they had resided. These vaPS cells are of high relevance for clinical application because they are contained in unmodified, autologous, adipose-derived regenerative cells (UA-ADRCs). The latter can be obtained from and re-applied to the same patient at the point of care, without the need for further processing, manipulation, and culturing. These findings as well as various clinical examples presented in this paper demonstrate the potential of UA-ADRCs for enabling an entirely new generation of medicine for the benefit of patients and healthcare systems.

Summary:. Necrobiosis lipoidica (NL) is a rare granulomatous skin disorder of unknown physiopathology that is frequently associated with diabetes mellitus. The typical skin lesions of NL present as chronic, bilateral, well-defined red to yellow-brown plaques with telangectasias, a violaceous border and a waxy atrophic center. The lower legs are the most often involved areas, but NL may exceptionally develop on scar tissue following surgery. The treatment is very challenging and notoriously difficult. We report a 60-year-old diabetic woman who developed NL all along the surgical scars following breast reduction, without presenting NL on the lower legs. NL should be considered among the rare but possible skin healing complications of surgery.

Introduction Nested graft is a surgical technique that allows to manage difficult-to-treat medical conditions such as chronic cutaneous ulcers, thanks to the high efficacy it has in reverting the fibroblasts senescence. Because of its peculiar regenerative property, nested graft is a surgical technique suitable also for the treatment of cutaneous ulcers developing on fibrotic scar tissue. Case report We reported the case of a 45-year-old man, drug-addict, with a large ulcer on the back of the right forearm in the context of scar fibrotic tissue. This lesion resulted from a previous heroin extravasation treated with a dermo-epidermal skin graft, that was accidentally scratched away by mechanical trauma. After several therapeutic failures with topical medications, we decided to treat the ulcer performing a skin graft using the nested graft technique. No adverse events were reported by the patient during or after the surgery. At the clinical evaluation performed three years later the wound was completely healed. Conclusions Nested graft represents a safe and easy-to-use technique that can be successfully used to treat ulcers on scar tissue, ensuring the achievement and the long-term maintenance of optimal resistance and aesthetic results.

Introduction. It is generally known that dermal fillers are widely used in anti-aging medicine, to provide volume in healthy skin and mucous tissue. Fillers can also be successfully used with concave scars in order to lift the tissue and to give third dimension to the retracted skin surface. The aim of this case report was to show successful non-surgical treatment with hyaluron filler of the post-traumatically deformed upper lip. Case outline. We report a case of a woman with asymmetric partly incompetent upper lip, after trauma and primary surgical reconstruction. After almost 12 years, reconstruction with hyaluron filler was performed, using linear retrograde and bolus technique. Conclusion. Presented case correction of the posttraumatic scar of the upper lip illustrates that good aesthetic results could be achieved with hyaluron fillers.

“Ghosts” are fibrinous remnants that become visible during transvenous lead extraction (TLE). Methods: Data from transoesophageal echocardiography-guided TLE procedures performed in 1103 patients were analysed to identify predisposing risk factors for the development of so-called disappearing ghosts—flying ghosts (FG), or attached to the cardiovascular wall—stable ghosts (SG), and to find out whether the presence of ghosts affected patient prognosis after TLE. Results: Ghosts were detected in 44.67% of patients (FG 15.5%, SG 29.2%). The occurrence of ghosts was associated with patient age at first system implantation [FG (OR = 0.984; p = 0.019), SG (OR = 0.989; p = 0.030)], scar tissue around the lead (s) [FG (OR = 7.106; p < 0.001, OR = 1.372; p = 0.011), SG (OR = 1.940; p < 0.001)], adherence of the lead to the cardiovascular wall [FG (OR = 0.517; p = 0.034)] and the number of leads [SG (OR = 1.450; p < 0.002). The presence of ghosts had no impact on long-term survival after TLE in the whole study group [FG HR = 0.927, 95% CI (0.742–1.159); p = 0.505; SG HR = 0.845, 95% CI (0.638–1.132); p = 0.265]. Conclusions: The degree of growth and maturation of scar tissue surrounding the lead was the strongest factor leading to the development of both types of ghosts. The presence of either form of ghost did not affect long-term survival even after TLE indicated for infection.

Rectovaginal fistula (RVF) is a type of anastomotic leakage that may occur after low anterior resection for rectal cancer. The repair of RVF can be challenging because of the scar tissue stenosis and incomplete obstruction. Two patients presented in our department with vaginal faecal discharge almost 7 months after the radical resection of rectal cancer. On vaginal examination, titanium nails related to the rectal surgery were found in the vaginal wall. The patients were diagnosed with RVF. Considering that RVF positions in the patients were high and might adhere to the pelvic tissue, a combined transabdominal–transanal resection and vaginal repair surgery was performed. About 3 months after surgery, both patients underwent colonic closure surgery, with consequent good recovery. A combined transabdominal–transanal approach may provide distinct advantages in surgical repair of difficult cases of RVF.

BackgroundMagnetic compression for creating gastrojejunostomy has many advantages according to previous studies. However, following mechanical device release after healing, the anastomotic stenosis becomes the pivotal point.MethodsRectangle-shaped magnets were used for magnetic compression in rabbits. Both paclitaxel-loaded magnets and a strategy of pyloric ligation were chosen to improve the gastrojejunostomy. Based on these choices, the half-capsule was applied to occlude the pylorus after anastomotic formation. The size and patency of the anastomoses were analyzed to evaluate the efficacy of these approaches. A histological examination was also performed.ResultsThe positive effect of ligating the pylorus on gastrojejunostomy was significantly greater than that achieved using paclitaxel-loaded magnets during either short- or long-term follow-up. There were fewer scar tissue and collagen fibers at the anastomotic site in the treatment group than in the control group. The anastomotic aperture was of great interest at 9 months after the ligation of the pylorus following magnetic compression. In the view of the jejunum, although the aperture was barely visible, gastric juice was continuously spilling through it like a spring, and the aperture was clearly visible from the stomach side. All half-capsules failed to block the pylorus.ConclusionThe effect of paclitaxel on maintaining gastrojejunostomy patency was temporary. The ligation of the pylorus ensured the long-term patency of gastrojejunostomy, and the aperture was comparable to the pylorus which could play an anti-reflux role. Further studies for the sort of gastrointestinal aperture are being planned.

The failure of axonal regeneration after spinal cord injury (SCI) results in permanent loss of sensorimotor function. The persistent presence of scar tissue, mainly fibrotic scar and astrocytic scar, is a critical cause of axonal regeneration failure and is widely accepted as a treatment target for SCI. Astrocytic scar has been widely investigated, while fibrotic scar has received less attention. Here, we review recent advances in fibrotic scar formation and its crosstalk with other main cellular components in the injured core after SCI, as well as its cellular origin, function, and mechanism. This study is expected to provide an important basis and novel insights into fibrotic scar as a treatment target for SCI.

Background:Muscle strain injury leads to a high risk of recurrent injury in sports and can cause long-term symptoms such as weakness and pain. Scar tissue formation after strain injuries has been described, yet what ultrastructural changes might occur in the chronic phase of this injury have not. It is also unknown if persistent symptoms and morphological abnormalities of the tissue can be mitigated by strength training.Purpose:To investigate if heavy resistance training improves symptoms and structural abnormalities after strain injuries.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 30 participants with long-term weakness and/or pain after a strain injury of the thigh or calf muscles were randomized to eccentric heavy resistance training of the injured region or control exercises of the back and abdominal muscle. Isokinetic (hamstring) or isometric (calf) muscle strength was determined, muscle cross-sectional area measured, and pain and function evaluated. Scar tissue ultrastructure was determined from biopsy specimens taken from the injured area before and after the training intervention.Results:Heavy resistance training over 3 months improved pain and function, normalized muscle strength deficits, and increased muscle cross-sectional area in the previously injured region. No systematic effect of training was found upon pathologic infiltration of fat and blood vessels into the previously injured area. Control exercises had no effect on strength, cross-sectional area, or scar tissue but a positive effect on patient-related outcome measures, such as pain and functional scores.Conclusion:Short-term strength training can improve sequelae symptoms and optimize muscle function even many years after a strain injury, but it does not seem to influence the overall structural abnormalities of the area with scar tissue.Registration:NCT02152098 (ClinicalTrials.gov identifier).

Cases We present 3 patients who underwent ulnar nerve transposition and wrapping of the nerve with human amniotic membrane (HAM). All 3 patients subsequently required a reoperation for the original pathologic condition (not for ulnar nerve symptoms), necessitating the exploration and dissection of the transposed ulnar nerve. We demonstrate the lack of scar formation and ease of separation between nerve and surrounding tissue, as well as histology in one case taken from the perineural tissues (previous amniotic membrane), demonstrating no inflammatory cells or absence of scar tissue formation. Conclusion Exploration and dissection of a previously transposed ulnar nerve can be facilitated by wrapping the nerve with HAM to prevent scarring and perineural fibrosis.

Background:The scalpel was once the gold standard for surgical incisions. Electrosurgery has started to supplant scalpels but is not yet acceptable for skin incisions due to the risk of burns and deeper injury relative to the scalpels’ neat incision with less tissue damage.The unnecessary burden of excessive scar formation makes comparing these two methods challenging. Therefore, this study aims to compare post-incision skin scarring created after monopolar electrosurgery and scalpel surgery, and also to evaluate the suitability of the Patient and Observer Scar Assessment Scale (POSAS) for assessing skin incision scars by comparing patients’ and observers’ scores. Methods:This self-controlled study involved patients undergoing elective and emergency skin surgery procedures during which a singular wound site was created using two incision methods (monopolar electrosurgery and scalpel) simultaneously. Post-incision scar tissue formation was evaluated using the POSAS, a subjective scar assessment tool that involved patients self-reporting on pain, itching, color, thickness flexibility, and surface relief and also an observer rating vascularity, pigmentation, thickness, flexibility, and surface relief both using a 5-point Likert-type scale. This assessment was performed three months post-surgery and the results were analyzed by a battery of statistical tests including a linear regression model. Results:Twenty patients were included in this study. Data analyzed using the paired t-test or Wilcoxon rank-sum test indicated there were no statistically significant differences between the scar tissue created by monopolar electrosurgery and scalpels according to both the patients and the observers. Correlation analyses between the patients’ and observers’ total POSAS scores indicated these followed a moderate linear relationship (r = 0.51; p < 0.001). Conclusion:Scar tissue from skin incisions made by monopolar electrosurgery were essentially indistinguishable from those created with a scalpel. The POSAS instrument is an acceptable means of assessing scar formation on the skin.&nbsp