Successful treatment of thyroidectomy scar with a pneumatic needleless injector and silicone gel
Notice bibliographique
Résumé
Thyroidectomy is the most frequently used method when performing surgery for thyroid cancer. A transverse incision on the neck is typically used to approach the thyroid; scar formation in highly visible areas of the neck is a consequence of using this method. The mean score of the Dermatology Life Quality Index for persons who have a thyroidectomy scar is similar to the mean score of patients with psoriasis and severe atopic dermatitis 1. In this study, we report the effects of a pneumatic needleless injector and silicone gel on scar remodelling in the case of a male patient with a thyroidectomy scar. A 41-year-old male patient visited our hospital to lessen the conspicuousness of a thyroidectomy scar (Figure 1). He underwent a total thyroidectomy and bilateral central node dissection 2 weeks prior to his visit. He had an erythematous protruding scar, with a length of 6 cm and a thickness of 3 mm. The Vancouver Scar Scale (VSS), including pigmentation, vascularity, pliability and height, was used for clinical assessment. The first time the patient presented, his VSS score was 7 points. We had him apply a silicone gel sheet (Scar-Clinic™; Hans Biomed / Ildong Pharmaceutical Co, Ltd, Seoul, Korea) to only the left side of his scar. We had the patient use the silicone gel sheet for 12 hours every day for a total period of 4 months. The silicone sheet used to treat the patient in this study had identical features to other silicone gel products (1.5–2.5 mm thick; permeability rate, 0.23–0.27), with a thickness of 2.5 mm and a permeability rate of 0.23. Furthermore, we utilised a pneumatic needleless injector with the intention of improving the cosmetic outcome. We treated the patient with a pneumatic needleless microjet injection device (INNOJECTOR™; Amore Pacific Co, Ltd, Seoul, Korea) on the entire thyroidectomy scar once a month for a total of four times. We injected normal saline into the dermis through a small entry point, with 0.10 ml injections at 2 mm intervals. Four months later, the left side, which was treated using both the silicone gel and pneumatic needleless microjet injection device, had a VSS score of 0; the right side, which was treated only with a pneumatic needleless microjet injection device, had a VSS score of 2 (Figure 2). Silicone gel is well known for reducing hypertrophic scars. Its semi-occlusive nature has been found to improve scars by providing adequate, but not excessive, hydration. Thus, silicone gel serves as an occlusion that causes a decrease in TEWL and restores the normal hydration state of keratinocytes. This causes dermal fibroblasts to downregulate extracellular matrix production 2. In another study, it was reported that in the case of silicone gel sheet-treated scars, the expression of transforming growth factor-β1 and platelet-derived growth factor was significantly lower compared with the case of untreated scars 3. Hirshowitz et al. reported that polarisation of the scar tissue caused by the negative static electric change could be a possible mechanism of reducing scar tissue 4. Treatment using a pneumatic needleless microjet injection device on a hypertrophic scar of the forehead caused a protruding scar to become flat 5. An accelerated jet pierces the epidermis through a small entry point through this device. It can inject the solution into the epidermis at a high speed of up to 180 m/s using pressurised air, distributing the solution intradermally by means of liquid-propelled compressed gases. Particles of the medical materials only enter the dermis to a controlled depth, received by strong pressure from the device. The liquid is dispersed into the skin in a near-spherical shape because of the stagnation of the jet at the end of the hole 6. This hole is thought to provide the necessary space for remodelling by inducing dermal microtrauma 7. There were no cases of splitting application to only one side of a scar to compare their effects. There appears to be a synergistic effect between these two methods for scar remodelling when dealing with treatment of a thyroidectomy scar. An in vivo study that investigates this hypothesis is needed as is a protocol developed through a large-scale study. This study was supported by 'User (Hospital) Test for Domestic New Medical Device' of the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea. The authors report no declarations of interest. Joon Seok1, Hyun J Kwon1, Sun Y Choi1, Kwang H Yoo2, Chang T Oh1,3, Beom J Kim1 1Department of Dermatology Chung-Ang University College of Medicine Seoul, Korea 2Department of Dermatology Catholic Kwandong University International St. Mary's Hospital Incheon, Korea 3Department of Medicine, Graduate school Chung-Ang University Seoul, Korea beomjoon@unitel.co.kr
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».