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Case Studies

CASE STUDY – University of Illinois Student

By: Philip Narini, MD, FACS, Chief of Plastic Surgery at Lakeridge Health Corp., Oshawa, Ontario

Shown below are photos of a 24 year old college student that sustained this laceration during an assault with a knife. The wound was through-and-through the upper lip and cheek. It was sutured and repaired primarily in the emergency department.

This case demonstrates the effective results after treatment of an acute facial laceration with NewGel+.

October 27, 2007(Before using NewGel+)

Approximately 2 weeks after the lip repair, he was treated with NewGel+ which he used 12 hours per day seven days per week.

February 15th, 2008 (After 12 weeks using NewGel+)

The pictures taken at 12 weeks post injury show a dramatic result with no perceptible scar across the lip or vermillion border. Only a small portion of the scar in the upper third of his face is minimally visible.

Case Report: Silicone Gel Sheeting for Treatment of Complex Keloid

By: Michael Gellis, M.D., F.A.C.S., Chairman of Plastic Surgery at William Beaumont Hospital, Royal Oak, Michigan

September 24th, 2008

original keloid scar prior to surgical removal.

ABSTRACT:
Silicone gel sheeting has been used for many years as a treatment for hypertrophic and keloid scars. This case report presents a patient who sustained a complex keloid scar in the right side of the face and had significant improvement by preventing the keloid from forming again after using the NewGel+ silicone gel sheeting.

HISTORY:
The patient is a 56 year old woman who had a complex old keloid that formed several years ago from a previous injury.

On November 20, 2008, the keloid was surgically removed. On January, 21, 2009, the patient complained of keloid formation again, as well as discomfort and a sensation of tightness around the surgical area. The patient started treatment with NewGel+ topical silicone gel sheeting placed over the scar.

RESULTS:
The patient used NewGel+ silicone gel sheeting over the surgical scar area that started to form another keloid scar. As shown in Fig-3 the patient had significant improvement in removing and preventing the keloid from forming as well as significant fading of the surgical scar being treated with only NewGel+ silicone gel sheeting.

CONCLUSION:
This case report describes a patient who had significant overall improvement in the hypertrophic scarring of her complex keloid scarring of the right side of the face.

January 21st, 2009 (Before using NewGel+)

the keloid began to form again after first keloid scar was surgically removed.

March 5th, 2009 (After only 6 weeks of using NewGel+)

after six weeks of treating the keloid with NewGel+.

Silicone Sheeting for Treatment of Hypertrophic Scarring for Complex Arm Wound:

Jack T. Peterson, Jr., M.D., F.A.C.S., Chief of Surgery, St. Francis Health Center, Topeka, Kansas

ABSTRACT:
Silicone gel sheeting has been used for many years now as a treatment for hypertrophic and keloid scars. This case report presents a patient who sustained a complex open wound of the upper arm and developed hypertrophic scarring and who had significant improvement with topical silicone gel sheeting.

HISTORY:
This patient is a 44-year-old woman who was injured when she was attacked by her horse and sustained a complex open wound avulsion injury of her anterior medical left upper arm from a horse bite (see Fig.1). The patient had a complete loss of skin and soft tissue down to the bicep's fascia with a defect measuring 10x15 cm. The patient presented to the emergency room. The avulsed tissue was retrieved. The patient was taken to the operating room that day, where the avulsed tissue was surgically replanted. Unfortunately this tissue did not survive, and the patient was left with a complex wound measuring 10x15 cm. The tissue was surgically debrided, and this complex open wound was allowed to granulate. The patient was returned to the operating room approximately 1 month later for her second procedure. The patient had a split thickness skin graft reconstruction of this complex open wound. The patient’s split thickness skin graft healed with a 100% take, but the patient developed hypertrophic scarring, particularly around the edges of the graft (see Fig. 2). The patient complained of discomfort and a sensation of tightness around this area of grafting. This hypertrophic scarring was treated with placement of topical silicone gel sheeting

RESULTS:
The patient used NewGel+ silicone gel sheeting over the area of scarring and split thickness skin graft topically once the area of split thickness skin grafting had completely healed, beginning about four months after her original injury and about three months after her split thickness skin graft. The patient had significant improvement in her scarring with improvement in the thickness, redness and tightness of the scar with her topical scar management (see Fig. 3). Fig. 4 shows even more significant improvement after 4 months of using NewGel+.

CONCLUSION:
This case report describes a patient who had significant overall improvement in her hypertrophic scarring of her complex open wound of the upper arm with the use of topical silicone gel sheeting.

July 9th,2007 (Before using NewGel+)

(almost 2 months after weeks of split thickness skin graft, hypertrophic scar) before using NewGel+

August 15, 2007

after 3 weeks of using NewGel+ (about 3 months post skin graft) of using NewGel+

November 20, 2007

after 4 months of using NewGel+

Silicone Gel Sheeting after Vertical Breast Reduction - A Case Study:

P.P. Narini, M.D., M.Sc., F.R.C.S.C., F.A.C.S., Chief of Plastic Surgery, Lakeridge Health Corp., Oshawa, Ontario

ABSTRACT:
Silicone gel sheeting has been used for some time to manage scars. This study was done to determine if silicone gel sheeting would affect the healing of a scar after a vertical reduction mammoplasty. The patient has functioned as her own control with the treatment of one side and the opposite side functioning as an untreated control. Early results demonstrate improvement in scar appearance, texture, and contour with improved patient satisfaction.

PROTOCOL:
This study was done as a pilot study to qualitatively determine if the application of silicone gel sheeting using the NewGel+ product (see Fig.1) can affect scar appearance after vertical reduction mammoplasty. The 20 year old patient was randomly selected as an average mammoplasty patient with no significant medical problems, as a non-smoker, and no contraindications to the use of silicone gel with no previous sensitivity documented. Scars are simply evaluated qualitatively for visual difference, colour change, surrounding skin changes, and clinically evaluated for texture. Informed consent was obtained from the patient prior to participating in the study.

PROCEDURE:
A vertical reduction mammoplasty was performed using standard breast reduction technique with the removal of 416 grams of tissue from the right side and 418 grams of tissue from the left side. The wounds were closed with absorbable monofilament (poliglecaprone) buried 3-0 dermal sutures and staples. Staples were removed on post-operative day 5 and steri-strips applied. These were removed after one week. Post-operative pictures were taken three weeks after surgery with no significant difference between the two sides. Silicone gel sheeting was provided (NewGel+, see Fig. 2) to the patient for treatment of the left side only. No treatment was given for the right side. Treatment side was randomly chosen post-operatively. The silicone sheeting was worn for most of the day and replaced after 7 to 10 days.

RESULTS:
After treatment of the left side for seven weeks with NewGel+, the patient was re-assessed with photos (see Fig.3) and clinical assessment. There was significant less wrinkling of the scar and essentially no redness. The scar was clearly flat and softer. The patient could clearly see a difference and was much more satisfied with the results on the treated side. Due to the dramatic changes demonstrated, the study was discontinued and silicone sheeting applied to the right side (see Fig. 4) as well as the left, for on-going scar management.

DISCUSSION:
Silicone gel sheeting has had a beneficial effect on the cosmetic appearance of a post-operative scar in a patient undergoing a vertical reduction mammoplasty. Although the mechanism of action has yet to be determined, this pilot study clearly has demonstrated an improvement in scar appearance and patient satisfaction. This patient had no risk factors for abnormal healing, was a nonsmoker and otherwise healthy. Also, she had a modest sized reduction mammoplasty and would be expected to heal without complications. The results seen at 10 weeks post-operatively are somewhat surprising since one would not expect a dramatic change this early in the healing phase. It would be anticipated that scar remodeling would have to take place over many months, with scar maturation to occur, prior to seeing a clinically significant effect from the application of silicone gel sheeting. However, this study has demonstrated an early effect. Certainly, before recommending the wide-spread and routine use of silicone gel sheeting in reduction mammoplasty, further study is required to investigate the affects on a variety of skin types, reduction size, reduction techniques, and concomitant risk factors. However, this case study is encouraging and suggests that silicone gel sheeting can improve cosmetic outcome and patient satisfaction.

CONCLUSION:
This case study has demonstrated significant improvement in the early cosmetic outcome of scars resulting from vertical reduction mammoplasty. Patient satisfaction has also been improved. Consideration may be given to the use of silicone gel sheeting in the early post-operative period.