The Experts below are selected from a list of 177 Experts worldwide ranked by ideXlab platform
George W Elgart - One of the best experts on this subject based on the ideXlab platform.
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comparison of the effects of short and long pulse durations when using a 585 nm pulsed dye laser in the treatment of new surgical scars
Lasers in Medical Science, 2010Co-Authors: Keyvan Nouri, Mohamed L Elsaie, Voraphol Vejjabhinanta, Mark R Stevens, Shalu S Patel, Caroline V Caperton, George W ElgartAbstract:More than 70 million surgical procedures are performed annually in the USA with the majority involving a skin lesion and almost all individuals in their lifetime will have one or more surgical procedures resulting in scars. Patients and physicians alike are thereby motivated to improve the cosmetic outcome of scars. Prior studies have shown that the pulsed dye laser (PDL) is effective in improving the quality and appearance of the scar when using the 585-nm PDL immediately after the Removal of Sutures. Most published studies used a pulse duration of 450 µs, which along with the other study parameters, has led to an overall improvement of the scars. However, a pulse duration of 1.5 ms is also available when using the pulsed dye laser and it should theoretically cause fewer side-effects. To our knowledge, there are no other studies comparing the effectiveness of different pulse durations in the treatment of surgical scars starting on the day of suture Removal. The purpose of this study is to compare the effect of different pulse durations (450 µs vs. 1.5 ms) in the treatments of postsurgical linear scars immediately after suture Removal when using the 585-nm pulsed dye laser (PDL). Twenty non-hospitalized male and female patients (older than 18 years of age) with skin types I–IV and with postoperative linear scars measuring at least 2.1 cm were enrolled in this prospective study. Scars were randomly divided into three equal sections. The different fields were randomly chosen to receive treatment (two out of three fields) or remain as control (one field). The two fields chosen to be treated received treatment with the 585-nm PDL using a 7-mm spot size at 4.0 J. One of the treated sections was randomly selected to receive a pulse duration of 450 µs, and the other section to receive a 1.5-ms pulse. The remaining scar section was designated as control (no treatment). The three sections were mapped and recorded. The patient received treatment immediately after the Sutures were removed from the wound and then monthly for 3 months. Evaluations were performed before each treatment and 1 month after the last treatment. The short-pulse and long-pulse 585-nm PDL-treated sections demonstrated a statistically significant overall average improvement of the VSS of 92 and 89%, respectively, compared to 67% for the control site (Fig. 1). Further, for individual parameters of the Vancouver scar scale (VSS), there were significant (p < 0.05) differences between control and treatment groups for all parameters, but there were no differences between the short- and long-pulse treatment groups for any parameter. Both short-pulse and long-pulse PDL are safe and effective in improving the quality and cosmetic appearance of surgical scars in skin type’s I–IV starting on the day of suture Removal with no significant difference between the two pulse durations.
Mohamed L Elsaie - One of the best experts on this subject based on the ideXlab platform.
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comparison of the effects of short and long pulse durations when using a 585 nm pulsed dye laser in the treatment of new surgical scars
Lasers in Medical Science, 2010Co-Authors: Keyvan Nouri, Mohamed L Elsaie, Voraphol Vejjabhinanta, Mark R Stevens, Shalu S Patel, Caroline V Caperton, George W ElgartAbstract:More than 70 million surgical procedures are performed annually in the USA with the majority involving a skin lesion and almost all individuals in their lifetime will have one or more surgical procedures resulting in scars. Patients and physicians alike are thereby motivated to improve the cosmetic outcome of scars. Prior studies have shown that the pulsed dye laser (PDL) is effective in improving the quality and appearance of the scar when using the 585-nm PDL immediately after the Removal of Sutures. Most published studies used a pulse duration of 450 µs, which along with the other study parameters, has led to an overall improvement of the scars. However, a pulse duration of 1.5 ms is also available when using the pulsed dye laser and it should theoretically cause fewer side-effects. To our knowledge, there are no other studies comparing the effectiveness of different pulse durations in the treatment of surgical scars starting on the day of suture Removal. The purpose of this study is to compare the effect of different pulse durations (450 µs vs. 1.5 ms) in the treatments of postsurgical linear scars immediately after suture Removal when using the 585-nm pulsed dye laser (PDL). Twenty non-hospitalized male and female patients (older than 18 years of age) with skin types I–IV and with postoperative linear scars measuring at least 2.1 cm were enrolled in this prospective study. Scars were randomly divided into three equal sections. The different fields were randomly chosen to receive treatment (two out of three fields) or remain as control (one field). The two fields chosen to be treated received treatment with the 585-nm PDL using a 7-mm spot size at 4.0 J. One of the treated sections was randomly selected to receive a pulse duration of 450 µs, and the other section to receive a 1.5-ms pulse. The remaining scar section was designated as control (no treatment). The three sections were mapped and recorded. The patient received treatment immediately after the Sutures were removed from the wound and then monthly for 3 months. Evaluations were performed before each treatment and 1 month after the last treatment. The short-pulse and long-pulse 585-nm PDL-treated sections demonstrated a statistically significant overall average improvement of the VSS of 92 and 89%, respectively, compared to 67% for the control site (Fig. 1). Further, for individual parameters of the Vancouver scar scale (VSS), there were significant (p < 0.05) differences between control and treatment groups for all parameters, but there were no differences between the short- and long-pulse treatment groups for any parameter. Both short-pulse and long-pulse PDL are safe and effective in improving the quality and cosmetic appearance of surgical scars in skin type’s I–IV starting on the day of suture Removal with no significant difference between the two pulse durations.
Frank Unglaub - One of the best experts on this subject based on the ideXlab platform.
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Die operative Dekompression des Ramus superficialis des Nervus radialis : Das Wartenberg-Syndrom (Operative Techniken)
Operative Orthopadie Und Traumatologie, 2020Co-Authors: Christian K. Spies, Lars Peter Müller, Johannes Oppermann, Wolfram F. Neiss, Peter F. Hahn, Frank UnglaubAbstract:ObjectiveOpen decompression of the superficial radial nerve is performed at the distal forearm in cases of circumscript entrapment. Broad-based entrapments can be treated by endoscopically assisted decompression.IndicationsEntrapment of the nerve along its course between the brachioradialis and extensor carpi radialis longus muscles or tendons. Persistent neuropathic pain with Tinel’s sign. Numbness distal to the entrapment in accordance to nerval innervation. Futile conservative treatment. Pathological electrophysiological findings.ContraindicationsEndogeneous neuropathy, bleeding disorders, anticoagulation medication.Surgical techniqueLongitudinal skin incision at the Tinel’s sign at the forearm. The subcutaneous tissue is dissected until forearm fascia is detected. The fascia is opened cautiously under direct visualization and the superficial radial nerve is identified. In cases of broad-based entrapments, endoscopically assisted decompression can be performed. The dissector with attached optical device is introduced proximally and distally. Blunt mobilization using the dissector and preparation with the Metzenbaum scissors release the superficial radial nerve sufficiently.Postoperative managementBandaging allowing immediate motion, Removal of Sutures after 14 days, avoidance of excessive use for 2 weeks.ResultsSurgical decompression of the superficial radial nerve yields good to excellent results regarding pain reduction and sensory function.
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Die operative Dekompression des Ramus superficialis des Nervus radialis
Operative Orthopädie und Traumatologie, 2016Co-Authors: Christian K. Spies, Lars Peter Müller, Johannes Oppermann, Wolfram F. Neiss, P. Hahn, Frank UnglaubAbstract:Objective Open decompression of the superficial radial nerve is performed at the distal forearm in cases of circumscript entrapment. Broad-based entrapments can be treated by endoscopically assisted decompression. Indications Entrapment of the nerve along its course between the brachioradialis and extensor carpi radialis longus muscles or tendons. Persistent neuropathic pain with Tinel’s sign. Numbness distal to the entrapment in accordance to nerval innervation. Futile conservative treatment. Pathological electrophysiological findings. Contraindications Endogeneous neuropathy, bleeding disorders, anticoagulation medication. Surgical technique Longitudinal skin incision at the Tinel’s sign at the forearm. The subcutaneous tissue is dissected until forearm fascia is detected. The fascia is opened cautiously under direct visualization and the superficial radial nerve is identified. In cases of broad-based entrapments, endoscopically assisted decompression can be performed. The dissector with attached optical device is introduced proximally and distally. Blunt mobilization using the dissector and preparation with the Metzenbaum scissors release the superficial radial nerve sufficiently. Postoperative management Bandaging allowing immediate motion, Removal of Sutures after 14 days, avoidance of excessive use for 2 weeks. Results Surgical decompression of the superficial radial nerve yields good to excellent results regarding pain reduction and sensory function. Operationsziel Ziel ist die operative Dekompression des Ramus superficialis des Nervus radialis im Bereich der Durchtrittsstelle durch die Fascia antebrachii. Langstreckige Einengungen können durch endoskopisch assistierte Dekompressionen am Unterarm behoben werden. Indikationen Einengungen des Ramus superficialis des N. radialis entlang der Sehnen und Muskelbäuche der Musculi brachioradialis et extensor carpi radialis longus. Persistierender neuropathischer Schmerz mit Hoffmann-Tinel-Zeichen. Taubheit im Versorgungsgebiet des Ramus superficialis distal der Einengung. Frustrane konservative Behandlung. Pathologische elektrophysiologische Messparameter des Ramus superficialis. Kontraindikationen Endogene Neuropathie, Blutungsneigung, antikoagulatorische Medikation. Operationstechnik Hautinzision seitlich versetzt zum provozierten Hoffmann-Tinel-Zeichen am Unterarm. Präparation des Subkutangewebes und Darstellung der Unterarmfaszie. Eröffnen der Faszie und Identifikation des Ramus superficialis des N. radialis. Bei langstreckigen Einengungen kann nun die endoskopisch assistierte Dekompression nach proximal und distal erfolgen. Durch Einführen des Dissektors mit Optik nach proximal und distal kann der Ramus superficialis teils stumpf durch Abschieben, teils mit der Metzenbaum-Schere, freigelegt werden. Weiterbehandlung Regelmäßige Verbandwechsel, Fadenentfernung nach 14 Tagen, Aufbelastung nach definitiver Wundheilung. Ergebnisse Nach Dekompression des Ramus superficialis zeigten sich überwiegend gute bis sehr gute Ergebnisse bezüglich Schmerzreduktion und Sensibilität.
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Die operative Dekompression des Ramus superficialis des Nervus radialis: Das Wartenberg-Syndrom
Operative Orthopadie Und Traumatologie, 2015Co-Authors: Christian K. Spies, Lars Peter Müller, Johannes Oppermann, Wolfram F. Neiss, Peter F. Hahn, Frank UnglaubAbstract:OBJECTIVE: Open decompression of the superficial radial nerve is performed at the distal forearm in cases of circumscript entrapment. Broad-based entrapments can be treated by endoscopically assisted decompression. INDICATIONS: Entrapment of the nerve along its course between the brachioradialis and extensor carpi radialis longus muscles or tendons. Persistent neuropathic pain with Tinel's sign. Numbness distal to the entrapment in accordance to nerval innervation. Futile conservative treatment. Pathological electrophysiological findings. CONTRAINDICATIONS: Endogeneous neuropathy, bleeding disorders, anticoagulation medication. SURGICAL TECHNIQUE: Longitudinal skin incision at the Tinel's sign at the forearm. The subcutaneous tissue is dissected until forearm fascia is detected. The fascia is opened cautiously under direct visualization and the superficial radial nerve is identified. In cases of broad-based entrapments, endoscopically assisted decompression can be performed. The dissector with attached optical device is introduced proximally and distally. Blunt mobilization using the dissector and preparation with the Metzenbaum scissors release the superficial radial nerve sufficiently. POSTOPERATIVE MANAGEMENT: Bandaging allowing immediate motion, Removal of Sutures after 14 days, avoidance of excessive use for 2 weeks. RESULTS: Surgical decompression of the superficial radial nerve yields good to excellent results regarding pain reduction and sensory function.
Keyvan Nouri - One of the best experts on this subject based on the ideXlab platform.
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comparison of the effects of short and long pulse durations when using a 585 nm pulsed dye laser in the treatment of new surgical scars
Lasers in Medical Science, 2010Co-Authors: Keyvan Nouri, Mohamed L Elsaie, Voraphol Vejjabhinanta, Mark R Stevens, Shalu S Patel, Caroline V Caperton, George W ElgartAbstract:More than 70 million surgical procedures are performed annually in the USA with the majority involving a skin lesion and almost all individuals in their lifetime will have one or more surgical procedures resulting in scars. Patients and physicians alike are thereby motivated to improve the cosmetic outcome of scars. Prior studies have shown that the pulsed dye laser (PDL) is effective in improving the quality and appearance of the scar when using the 585-nm PDL immediately after the Removal of Sutures. Most published studies used a pulse duration of 450 µs, which along with the other study parameters, has led to an overall improvement of the scars. However, a pulse duration of 1.5 ms is also available when using the pulsed dye laser and it should theoretically cause fewer side-effects. To our knowledge, there are no other studies comparing the effectiveness of different pulse durations in the treatment of surgical scars starting on the day of suture Removal. The purpose of this study is to compare the effect of different pulse durations (450 µs vs. 1.5 ms) in the treatments of postsurgical linear scars immediately after suture Removal when using the 585-nm pulsed dye laser (PDL). Twenty non-hospitalized male and female patients (older than 18 years of age) with skin types I–IV and with postoperative linear scars measuring at least 2.1 cm were enrolled in this prospective study. Scars were randomly divided into three equal sections. The different fields were randomly chosen to receive treatment (two out of three fields) or remain as control (one field). The two fields chosen to be treated received treatment with the 585-nm PDL using a 7-mm spot size at 4.0 J. One of the treated sections was randomly selected to receive a pulse duration of 450 µs, and the other section to receive a 1.5-ms pulse. The remaining scar section was designated as control (no treatment). The three sections were mapped and recorded. The patient received treatment immediately after the Sutures were removed from the wound and then monthly for 3 months. Evaluations were performed before each treatment and 1 month after the last treatment. The short-pulse and long-pulse 585-nm PDL-treated sections demonstrated a statistically significant overall average improvement of the VSS of 92 and 89%, respectively, compared to 67% for the control site (Fig. 1). Further, for individual parameters of the Vancouver scar scale (VSS), there were significant (p < 0.05) differences between control and treatment groups for all parameters, but there were no differences between the short- and long-pulse treatment groups for any parameter. Both short-pulse and long-pulse PDL are safe and effective in improving the quality and cosmetic appearance of surgical scars in skin type’s I–IV starting on the day of suture Removal with no significant difference between the two pulse durations.
Adrian Grant - One of the best experts on this subject based on the ideXlab platform.
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The Ipswich Childbirth Study : 1. A randomised evaluation of two stage postpartum perineal repair leaving the skin unsutured
British Journal of Obstetrics and Gynaecology, 1998Co-Authors: Beverley Gordon, Carolyn Mackrodt, Elizabeth Fern, Ann Truesdale, Sarah Ayers, Adrian GrantAbstract:Objective To evaluate a policy of two stage postpartum perineal repair leaving the skin unsutured. Design A stratified randomised controlled trial using a 2 × 2 factorial design. Setting The maternity unit at Ipswich Hospital NHS Trust, a district general hospital, between 1992 and 1994. Sample 1780 women requiring surgical repair of episiotomy or first or second degree tear following a spontaneous or simple instrumental delivery. Methods A policy of two-stage perineal repair leaving skin unsutured was compared with a policy of three stage repair including skin closure with interrupted or subcuticular Sutures. Both groups were assessed by a research midwife, blind to the allocation, completing questionnaires at 24 to 48 hours and 10 days postpartum, and by self-completed questionnaires at three months after birth. Main outcome measures 1. 24 to 48 hours postpartum: perineal pain; healing; 2. 10 days postpartum: perineal pain, healing and Removal of Sutures; 3. three months postpartum: perineal pain, Removal of Sutures, resuturing, dyspareunia, and failure to resume pain-free intercourse. Results Completed questionnaires were returned for 99% of women at both 24 to 48 hours and ten days and by 93% of women three months postpartum. No differences were detected in perineal pain at 24 to 48 hours (62%vs 64%; RR 0.96, 95% CI 0.90–1.03; 2P = 0.3) and 10 days (25%vs 28%; RR 0.90,95% CI 0.77–1.06; 2P = 0.2). Significantly fewer women allocated to two-stage repair reported tight stitches at ten days (14%vs 18%; RR 0.77, 95% CI 0.62–0.96, 2P = 0.02); similar numbers of repairs were judged to be breaking down (five compared with seven women). At three months postpartum fewer women allocated to the two-stage repair reported perineal pain and more had resumed pain-free intercourse. Amongst women who had resumed intercourse there was a significant difference in dyspareunia (15%vs 19%; RR 0.80, 95% CI 0.65–0.99; 2P = 0.04). Significantly fewer women in the two-stage repair group (7%vs12%; RR 0.61, 95% CI 0.45–0.83; 2P = < 0.01) reported Removal of suture material. Four women in the two-stage repair group had required resuturing, compared with nine allocated to the three-stage repair. Conclusions Two-stage repair of perineal trauma leaving the skin unsutured appears to reduce pain and dyspareunia three months postpartum. There are no apparent disadvantages, in particular no evidence of an increased risk of breakdown of the repair and resuturing.
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The Ipswich Childbirth Study: 2. A randomised comparison of polyglactin 910 with chromic catgut for postpartum perineal repair.
British Journal of Obstetrics and Gynaecology, 1998Co-Authors: Carolyn Mackrodt, Beverley Gordon, Elizabeth Fern, Ann Truesdale, Sarah Ayers, Adrian GrantAbstract:Objective To compare polyglactin 910 Sutures with chromic catgut Sutures for postpartum perineal repair. Design A stratified randomised controlled trial, using a 2 × 2 factorial design. Setting The maternity unit at Ipswich Hospital NHS Trust, a district general hospital, between 1992 and 1994. Sample 1780 women who had sustained an episiotomy or first or second degree tear following a spontaneous or simple instrumental delivery. Methods Policies of repair with polyglactin 910 or chromic catgut were compared. Both groups were assessed by a research midwife completing questionnaires at 24 to 48 hours and at ten days postpartum, and by self-completed questionnaires at three months after birth. Main outcome measures 1. 24 to 48 hours postpartum: perineal pain, healing; 2. ten days postpartum: perineal pain, healing and Removal of Sutures; 3. three months postpartum: perineal pain, Removal of Sutures, resuturing, dyspareunia, and failure to resume pain-free intercourse. Results Completed questionnaires were returned for 99% of women at both 24 to 48 hours and ten days and by 93% of women three months postpartum. The two groups were similar at trial entry. Significantly fewer women allocated to the polyglactin 910 reported pain in the previous 24 hours at both 24 to 48 hours (59%vs 67%; RR 0.89, 95% CI 0.83–0.95; 2P < 0.01), and ten days (24%vs 29%; RR 0.81, 95% CI 0.69–0.95; 2P = 0.01). At three months postpartum there was no clear difference between the groups in terms of perineal pain, dyspareunia or failure to resume pain-free intercourse. More women in the polyglactin 910 group reported that some suture material had been removed (12%vs 7%; RR 1.62,95% CI 1.19–2.21; 2P < 0.01). Three women in the polyglactin 910 group had required resuturing compared with ten in the chromic catgut group (RR 0.30; 95% CI 0.08–1.09; 2P=0.1). Conclusions Using polyglactin 910 rather than chromic catgut for perineal repair leads to about one fewer women among every 20 having perineal pain and using analgesia ten days postpartum. Its only apparent disadvantage is that more women, again estimated as 1 in 20, report having material removed during healing. Data from this and other trials suggest that for every 100 women repaired with a polyglycolic acid-based material, about one fewer will require resuturing.