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Functional Rehabilitation
Published in James Crossley, Functional Exercise and Rehabilitation, 2021
The sub-acute phase of soft tissue repair is characterized by ‘repair’ and is therefore often referred to as the ‘repair phase’. During this repair phase, damaged tissue is restored and regeneration occurs. The repair phase is characterized by: Scar tissue formationAngiogenesis Scar tissue formation is the next stage of healing and involves fibroblasts acting to produce and lay down collagen filaments. Immature scar tissue is deposited in a random or haphazard manner, and therefore injured tissue still lacks strength or resilience compared to the healthy tissue it replaces. The fragility of scar tissue makes the risk of re-injury in the repair phase high.
Scar Care after Surgical Treatment in Oncology Patients
Published in Paloma Tejero, Hernán Pinto, Aesthetic Treatments for the Oncology Patient, 2020
The detection of a cicatricial contracture that limits the joint range should make us consider the surgical revision of the scar. The prolonged joint limitation could cause changes at the joint level that would make this state chronic. Surgical revision includes the excision of scar tissue to identify a subcutaneous plane free of adhesions. Traditional surgical techniques for contractures include Z- and W-plasties. Our goal will be to achieve wound closure without tension and initiate an early rehabilitation program. Surgical revision is usually associated with aggressive neoplasm and oncological surgery and is frequently associated with lymphadenectomy or sarcomas of the extremities.
Complications of Fillers and Their Management
Published in Neil S. Sadick, Illustrated Manual of Injectable Fillers, 2020
Necrosis, the breakdown of tissue, is usually a consequence of vascular occlusion or compromise that occurs several days after the event. Heralded by a dusky appearance to the skin, this is followed by crusting. To prevent scar tissue formation, aggressive and diligent wound care should be instituted. Topical corticosteroids, silver preparations, and vasodilating agents should be applied assiduously several times a day until the wound is healed. Monitor for any superinfection and apply antibacterial agents if needed.
Can Nerve Growth Factor (NGF) Be a Treatment Option for Pediatric Eye Diseases?
Published in Seminars in Ophthalmology, 2023
Leyla Yavuz Saricay, Jose Efren Gonzalez Monroy, Anne B Fulton
The murine NGF was purified from mouse submaxillary salivary with specific methods and used experimentally in several different studies.38 With murine NGF, the first, an open-label non-controlled study, was performed by Lambiese et al.39 They reported 12 patients (14 eyes) with non-infectious corneal ulcer as a result of severe corneal neurotrophic keratopathy. Before initiating topical murine NGF treatment, 10 days of preservative-free artificial tears treatment was given. The topical treatment with murine NGF ((200 μg/mL) was initiated if there is no tendency to heal or if ocular perforation risk occurs due to the corneal ulcer progression. The complete corneal healing with scar tissue was achieved in 34 days on average (10–42 days). During follow-up, they did not observe any disease relapse or worsening of corneal integrity.39 Additionally, they presented corneal sensitivity improvement in 13 of 14 eyes. Following this important study, a prospective interventional study was completed by Bonini et al., using 43 stage 2–3 neurotrophic keratopathy patients who had been unresponsive to other conventional treatments.26 After the treatment with murine NGF, all patients achieved complete corneal healing and significantly improved visual acuity and corneal sensitivity.26 These promising findings opened many doors for NGF usage for many ocular indications.
Patient-Specific Orbital Implants Vs. Pre-Formed Implants for Internal Orbital Reconstruction
Published in Seminars in Ophthalmology, 2023
Daphna Landau Prat, Said Massarwa, Assa Zohar, Ayelet Priel, Oded Sagiv, Ofira Zloto, Guy J. Ben Simon
All surgeries were performed with the patient under general anesthesia. A forced duction test was performed at the beginning of each surgery, and any motility limitations were noted and marked. A swinging eyelid incision was used for all cases of orbital floor fractures, and an additional trans-caruncular incision was used to repair concomitant medial wall fractures. Blunt subperiosteal dissection was carried out to delineate the full length of the fracture, after which the posterior ledge was exposed. Any incarcerated orbital tissue within the sinuses was gently released and replaced into the orbit. Any existing scar tissue was excised. The implant in the PFI group was trimmed so that it could safely cover the full extent of the fracture on stable orbital bones. The PSI was used as provided by the manufacturer without further preoperative or intraoperative manipulations. A zero-degree 4 mm endoscope was used in selected cases to ensure accurate implant position at the posterior aspect. A forced duction test was performed at the end of surgery, and when needed, additional release of peri-implant tissue was performed. The surgical incision was sutured with interrupted 7/0 and 6/0 polyglactin 910 sutures (Vicryl®, Ethicon, New Brunswick, New Jersey, USA).
A 2020 Update on 20/20 X 2 Diplopia after Ocular Surgery: Strabismus Following Retinal Detachment Surgery
Published in Journal of Binocular Vision and Ocular Motility, 2021
This is the most common pattern reported in the literature. It is characterized by a limited ocular rotation away from the field of action of the affected muscle. Causes include mechanical restriction due to tightness of the affected muscle, scar tissue formation to periorbital tissue, and conjunctival restriction. The forced duction test is positive in the opposite field of gaze but negative in the ipsilateral field. An anterior displacement of the scleral buckle can result in a similar pattern. Surgical management includes release of scar tissue. In patients with deviation in primary position, simultaneous weakening the affected muscle is required. This can be achieved by recessing the affected muscle, removing the buckle or a segment of the buckle, or repositioning the scleral buckle if displaced anteriorly; in patients without deviation in the primary position repositioning the affected muscle under the buckle or removing the buckle or a segment of the buckle can release the restriction in opposite gaze (Figure 1).