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Indian Journal of Plastic Surgery, Vol. 36, No. 2, , 2003, pp. 142-143 Abstract Intralesional Cryotherapy for enhancing the Involution of Hypertrophic Scars and Keloids / Treatment of Keloids by surgical excision and immediate post operative single-fraction Radiotherapy / Recall dysfunction: Significance in the post-operative patient Kumar P Kasturba Medical College, Manipal Code Number: pl03036 Intralesional Cryotherapy for enhancing the Involution of Hypertrophic Scars and Keloids Surface contact or spray cryotherapy has been shown to normalize the collage in hypertrophic scars and keloids. It requires 1-20 treatment sessions and might produce severe pain, ulceration and permanent hypo-pigmentation. This present study was designed to assess the clinical safety and efficacy of Intralesional needle cryoprobe method in the treatment of these scars. A significant reduction of scar volume, objective parameters and subjective complaints were achieved after a single intralesional cryotherapy. The ratio of red (mature ) to green (immature) collagen fibers after picrosirius red staining revealed significant reduction in post treated specimens as compared to that in pretreated biopsy specimen. The orientation index was also significantly higher (indicating more organized architectural pattern of the collagen) in the post treated scar. This study demonstrates that intralesional cryotherapy method under study was simple to operate and more efficient method of freezing scars with greater destruction of deep scar material. Treatment of Keloids by surgical excision and immediate post operative single-fraction Radiotherapy The purpose of this retrospective study with up to 5-year outcome data of a single treatment team was to review the results of Marsden (Royal Morsden Hospital, UK) Protocol for treatment of Keloid. Participants (n=80) with age range12-53 years (Mean 25) were treated for 80 keloids (59% females, 76% nonwhite patients) with majority of keloids located on earlobes (44%). The keloids were excised extralesionally, primary closure was done with 4-0/5-0 prolene suture (Ethicon, Johnson and Johnson, UK) and dressing was done with non-opaque, semi-occlusive poly urethane adhesive film (Opsite, Smith and Nephew, UK) after applying topical lignocaine hydrochloride and chlor hexidine gel. Adjuvant postoperative radiotherapy ( 60-kV or100kV photon radiation at a 25-cm source to skin distance using 2 or 4-mm aluminum filter to give a greater half-value thickness of 1.7 or 4-mm aluminum) was given within 24 hours of surgery. Followup was done at 4 weeks, 3 months, 6 months, and then annually within one clinic. Recurrence was defined as pain, itching or obvious return of lesion. Analysis was by actuarial analysis for incomplete data sets. At 1 year 6 of 64 patients had experienced treatment failure (probability of control at one year, 91%). At 5 years, an additional 4 of 54 patients followed had relapsed (cumulative probability of control at 5 years, 84%). Authors conclude that extralesional excision of keloid followed by early post-operative, single fraction of radiotherapy is both simple and effective in preventing recurrence at excision sites in high risk keloids that have failed prior treatment.Recall dysfunction: Significance in the post-operative patient Cognitive dysfunction in the post operative patient has been reported showing incomplete recall of preoperatively discussed risk and complications. Very few patients recall every thing that was discussed before surgery and this was attributed to the perioperative amnesiac medicines and stress of surgery. This study was conducted on 27 healthy medical students to determine if a normal individual, who has not undergone surgery, has difficulties recalling accurately subject matter read 30 days previously. Each of them were given two questionnaires related to the complication of abdominoplasty; second one 30 days after the first. Six of them did not respond to the questionnaires. First questionnaire was given and the possible risks and complications of the procedure were discussed. The second questionnaire, administered 30 days after first, required the subject to recall the possible risks and complications he or she had read before surgery. The result of the study demonstrated that 3.7% recall all risks and complications read 30 days previously. Seventy four percent of the healthy subjects recalled up to 50% of the total complications. This has an impact on the recall ability of patients post operatively when claims are made concerning lack of informed consent. To conclude, patient recall of informed consent discussions should be suspect as to its accuracy.References
Copyright 2003 - Indian Journal of Plastic Surgery |
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