Dermatologic Surgery (dermatologic + surgery)

Distribution by Scientific Domains


Selected Abstracts


CONTROVERSIES IN DERMATOLOGIC SURGERY

DERMATOLOGIC SURGERY, Issue 3 2000
Article first published online: 6 OCT 200
No abstract is available for this article. [source]


Contribution of Dermatologic Surgery in War

DERMATOLOGIC SURGERY, Issue 1 2010
MAJOR J. SCOTT HENNING DO
BACKGROUND Despite the large contribution by dermatology to military readiness, there have been no published reports regarding dermatologic surgery or skin cancer in the combat environment. OBJECTIVE To outline the contribution of dermatologic surgery, including skin cancer and benign tumors, to deployed service men and women in Operation Iraqi Freedom. METHODS A retrospective chart review was performed of all dermatology visits at the 86th Combat Support Hospital, Ibn Sina, Iraq, between January 15, 2008 and July 15, 2008. RESULTS Two thousand six hundred ninety-six patients were seen in the combat dermatology clinic during the 6-month period reviewed; 8% (205/2,696) of the total visits were for skin cancer, and another 129 patients were treated for actinic keratosis. The specific diagnoses were basal cell carcinoma (n=70), in situ and invasive squamous cell carcinoma (n=68), mycosis fungoides (n=1), bowenoid papulosis (n=1), and in situ and invasive melanoma (n=9). Benign lesions and tumors accounted for 14% (357/2,696) of total patient visits. Three hundred seven surgeries were performed during the 6-month period (178 skin cancers and 129 benign lesions), and 20 patients were referred for Mohs micrographic surgery. The surgical complications included five postoperative wound infections (1 methicillin-resistant Staphylococcus aureus), one wound dehiscence, and seven allergic contact dermatitis. CONCLUSIONS To the authors' knowledge, this is the first publication regarding skin cancer and dermatologic surgery in the combat setting. This report outlines the important contribution of dermatologic surgery in the combat environment. The authors have indicated no significant interest with commercial supporters. [source]


Detecting Adverse Events in Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 1 2010
DANIEL PINNEY BS
BACKGROUND Despite increasing awareness of and public attention to patient safety, little is documented about how adverse events (AEs) can or should be monitored in dermatologic surgery. Data to address this shortcoming are needed, although well-defined methodologies have yet to be implemented. OBJECTIVE To summarize current strategies in detecting adverse outcomes of dermatologic surgical procedures. MATERIALS AND METHODS A Medline literature search was conducted using the terms "adverse event,""detection,""reporting,""monitoring," and "surgery." Articles selected addressed the efficacy of one or more AE reporting techniques in surgical patients. RESULTS Prospective and retrospective reporting methods were identified, with morbidity and mortality conference being the most commonly used method of AE reporting. Retrospective medical record review, the retrospective trigger tool approach, and an anonymous electronic reporting system were more sensitive approaches. The Surgical Quality Improvement Program, a program that has successfully translated AE data into lower postoperative morbidity and mortality, was analyzed. CONCLUSIONS Although generally considered safe, dermatologic surgery has no current standard for AE reporting. Standard definitions and high-quality data regarding AEs" currently limit this analysis. Pilot studies are needed to develop feasible measures, with the goal of increasing the sensitivity of AE detection and ultimately improving patient outcomes. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories. [source]


Recent Trends in Cosmetic and Surgical Procedure Volumes in Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 9 2009
EMILY P. TIERNEY MD
BACKGROUND The number of cosmetic and noncosmetic surgical procedures performed by dermatologic surgeons has been rising rapidly, but there are few consistent data sources allowing procedure volumes to be tracked over time. METHODS American Society for Dermatologic Surgery member survey in 2001 to 2007 reporting cosmetic and noncosmetic procedural volumes (300,500 surgeons surveyed, response rate of 31,44%). RESULTS In 2001, dermatologic surgeons performed an estimated 3.4 million cosmetic and noncosmetic surgical procedures; in 2007, it was estimated that a total of 7.6 million procedures were performed (120.2% rate of growth between 2001 and 2007). The procedures with the greatest increase during this time period were soft tissue augmentation (405.0% increase), botulinum toxin injections (324.4% increase), and nonablative skin rejuvenation (laser, light, and radiofrequency sources) (330.7% increase). More modest increases were noted in skin cancer procedures (85.8% increase) and ablative resurfacing procedures (66.8% increase). CONCLUSION The magnitude of growth in procedural volumes over the last 8 years reflects the advancements in dermatologic surgery in treatments for skin cancer and in treatment of photoaging and cosmetic enhancement of the skin. [source]


Recent Changes in the Workforce and Practice of Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 3 2009
EMILY P. TIERNEY MD
BACKGROUND The increasing number of American College of Mohs Surgery (ACMS) fellowship positions over the last decade has resulted in a greater number of fellowship-trained surgeons in dermatologic surgery. METHODS Mohs micrographic fellowship-trained surgeons (MMFTSs) and non-Mohs fellowship-trained surgeons performing Mohs micrographic surgery (NMMFTSs) were compared using the American Academy of Dermatology Practice Profile Survey (2002/05). An analysis of recent Mohs fellowship classes was also performed. RESULTS In 2005, there was an equivalent proportion of MMFTSs and NMMFTSs in the workforce (ratio MMFTS:NMMFTS=0.9) but, in 2005, there was a shift in the youngest age cohort (29,39) to a greater proportion of MMFTSs (MMFTS:NMMFTS=1.55). In 2005, the youngest MMFTSs (29,39) were more likely to be female (47.1%) than of MMFTSs overall (24%). MMFTSs were 5 times as likely to be in full-time academic positions and performed 2 to 3 times as many Mohs cases per week as NMMFTSs. CONCLUSIONS Consistent with demographic shifts in dermatology, differences have emerged in the demographics, surgical volumes, and settings of MMFTSs and NMMFTSs. Recent increases in the ACMS fellowship positions have resulted in a greater proportion of MMFTSs among younger dermatologic surgeons. It will be important to follow how this increase in fellowship trainees affects the dermatologic surgery workforce. [source]


Prevalence of Methicillin-Resistant Staphylococcus aureus in the Setting of Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 3 2009
ROGER S. SICA DO
BACKGROUND The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the postoperative setting of dermatologic surgery is unknown. Such data could influence the empirical treatment of suspected infections. OBJECTIVE To examine the period prevalence of MRSA infections in the postoperative setting of dermatologic surgery. METHODS We performed chart reviews of 70 patients who had bacterial cultures taken from January 2007 to December 2007. In the 21 postsurgical cases, we analyzed age, risk factors, sites of predilection, method of repair, and pathogen of growth. RESULTS The mean age of the overall study population was 57, with the mean age of postsurgical MRSA-positive cases being 75.5. Of the 21 postsurgical cultures taken, 16 cultures grew pathogen, and two of the 16 (13%) pathogen-positive cultures grew MRSA. LIMITATIONS This is a retrospective chart review of a relatively small sample size in one geographic location. Our patient population is known to contain a large number of retirees. CONCLUSION The increasing prevalence of MRSA skin and soft tissue infections and recommendation to modify empirical antibiotic therapy have been well documented in particular patient populations, but we caution against the empirical use of MRSA-sensitive antibiotics in the postoperative setting of dermatologic surgery. We advocate culturing all infectious lesions upon presentation and reserve empirical use of MRSA-sensitive antibiotics for high-risk patients or locations. [source]


Perioperative Management of von Willebrand Disease in Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 4 2007
AIMEE L. LEONARD MD
BACKGROUND Von Willebrand disease (VWD) is the most common inherited bleeding disorder, affecting an estimated 0.1% to 1% of the population. It is caused by a qualitative or quantitative defect of von Willebrand factor. Primary manifestations include intractable mucocutaneous bleeding after surgery or trauma. OBJECTIVE The objective was to review the pathophysiology and clinical features of VWD and to propose a perioperative management strategy for patients with this condition undergoing dermatologic surgery. METHODS AND MATERIALS Literature is reviewed. RESULTS The various types and clinical manifestations of this condition are reviewed, and a perioperative strategy is presented for managing patients with VWD who undergo cutaneous oncologic or cosmetic surgical procedures. CONCLUSIONS In most cases, dermatologic surgery can be safely performed in patients with VWD. The use of appropriate therapeutic prophylaxis in conjunction with a hematologist is indicated in high-risk, nonelective procedures. [source]


Beauty Versus Medicine: The Nonphysician Practice of Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 4 2003
Harold J. Brody MD
Background This investigation was initiated because of a growing concern by the American Society for Dermatologic Surgery about the proliferation of nonphysicians practicing medicine and its impact on public health, safety, and welfare. Objective Prompted by an alarming rise in anecdotal reports among dermatologic surgeons, the study sought to determine whether there was a significant increase in the number of patients seeking corrective treatment due to complications from laser and light-based hair removal, subsurface laser/light rejuvenation techniques, chemical peels, microdermabrasion, injectables, and other cosmetic medical/surgical procedures performed by nonphysicians without adequate training or supervision. Methods A survey of 2,400 American Society for Dermatologic Surgery members in July 2001 and in-depth phone interviews with eight patients who experienced complications from nonphysicians performing cosmetic dermatologic surgery procedures were conducted. Results Survey data and qualitative research results attributed patient complications primarily to "nonphysician operators" such as cosmetic technicians, estheticians, and employees of medical/dental professionals who performed various invasive medical procedures outside of their scope of training or with inadequate or no physician supervision. Conclusion The results underscore the need for improved awareness, legislation, and enforcement regarding the nonphysician practice of medicine, along with further study of this issue. [source]


Antibiotic Prophylaxis Guideline Awareness and Antibiotic Prophylaxis Use Among New York State Dermatologic Surgeons

DERMATOLOGIC SURGERY, Issue 9 2002
Noah Scheinfeld JD
background. Use of antibiotic prophylaxis in dermatologic surgery patients remains controversial and several sets of guidelines exist. objective. We investigated dermatologic surgeon's awareness of the American Heart Association (AHA) 1997 antibiotic prophylaxis guidelines, their use of prophylactic antibiotics, and their practices as compared with the Haas and Grekin's 1995 antibiotic prophylaxis guidelines. methods. We mailed postage-paid questionnaires regarding AHA guideline awareness and antibiotic prophylaxis use to the 235 New York State members of the American Society for Dermatologic Surgery (ASDS). We received 87 replies. results. Most participants recognize AHA guidelines and claim to follow them. We reiterate previous studies' findings. Most dermatologic surgeons use antibiotics appropriately. However, antibiotics are occasionally overused or dosed outside the guidelines. Many participants prescribe antibiotics based on a patient's other physicians' recommendations. Notably, erythromycin is sometimes used, an antibiotic the AHA no longer recommends. conclusion. Dermatologic surgeons commonly use antibiotic prophylaxis to prevent bacterial endocarditis. Based on previous studies, though, the risk of endocarditis following cutaneous surgery is low and thus the use of antibiotic prophylaxis is controversial. Although this practice is appropriate for high-risk patients when skin is contaminated, it is not recommended for noneroded, noninfected skin. We report that dermatologists may be aware of the guidelines, but only seem to partially follow them. Further studies are still needed to establish optimal guidelines. [source]


The Significance of Articles Appearing in Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 12 2001
Nathalie Q. Nguyen BS
No abstract is available for this article. [source]


The Impact of Herbal Medicines on Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 8 2001
Lawrence K. Chang MD
Background. In recent years herbal medicines and supplements have become increasingly popular. With their increased popularity, more publications are warning about the potential harmful effects of some of these products. Objective. To present scientific evidence of the benefits and surgical risks of herbal products. Methods. A Medline search and review of the literature was performed. Results. Many herbal medicines are relevant in dermatologic surgery since Ginkgo biloba, garlic, ginger, ginseng, feverfew, and vitamin E may increase the risk of bleeding, and ephedra may potentiate the side effects of epinephrine. Conclusion. Dermatologists should be aware of these herbal products and their uses. Many of these products prescribed by alternative medicine physicians or purchased over the counter should be discontinued prior to dermatologic surgery to minimize the risk of surgical complications. [source]


The Impact of Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 12 2000
Nathalie Q. Nguyen BS
No abstract is available for this article. [source]


Authors in Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 12 2000
Nathalie Q. Nguyen BS
Authors of scientific papers have been evaluated in the past by how frequently the medical literature cites them. In this analysis, we specifically identify those individuals who have contributed to the field of cutaneous surgery through publications in Dermatologic Surgery. We further analyze those publications frequently cited in Dermatologic Surgery, allowing us to determine topics of utmost value and interest. Using a citation database provided by the Institute for Scientific Information, we first identify all publications and citations from 1981 to 1999 for Dermatologic Surgery and the Journal of Dermatologic Surgery and Oncology (the previous name for this journal). Of the original articles published during this time frame, 3099 authors published 2167 papers. We quantify the publications from each author, and identify 57 authors with at least 10 original articles. When expanding the database parameters to include original articles, reviews, notes, and proceedings (as defined by the Science Citation Index), we find that the eight authors with the greatest number of publications are the same individuals with the greatest number of original articles. This reflects significant contributions to the field of cutaneous surgery by these authors. This analysis further identifies source papers for authors in Dermatologic Surgery. Publications frequently cited include those papers discussing laser surgery, with Dermatologic Surgery serving as the most frequently cited journal. [source]


A History of Dermatologic Surgery in the United States

DERMATOLOGIC SURGERY, Issue 1 2000
William P. Coleman III MD
Background. Dermatologic surgery has a long and distinguished history in the United States. Objective. To examine the specific contributions of American dermatologic surgeons. Method. The medical literature on cutaneous reconstructive and cosmetic surgery for the last century and a half was researched. Results. Numerous American dermatologic surgeons have had a major impact on scientific and technological discoveries in cutaneous surgery. Dermatologic surgeons have been significantly involved in cutaneous surgery since the second half of the 19th century. Dermatologic surgeons have contributed many important advances to the fields of chemical peeling, cryosurgery, dermabrasion, electrosurgery, hair transplantation, soft tissue augmentation, tumescent liposuction, laser surgery, phlebology, Mohs chemosurgery, cutaneous reconstruction, wound healing, botulium toxin, blepharoplasty, and rhytidectomy. Conclusion. Dermatologic surgeons in the United States have contributed significantly to the history of reconstructive and cosmetic surgery. Dermatologic surgeons have been leaders in advancing this field and are poised to continue in the future. [source]


Legal considerations in cosmetic laser surgery

JOURNAL OF COSMETIC DERMATOLOGY, Issue 2 2006
David J Goldberg MD
Summary Cosmetic laser surgery is a continuously evolving field of medicine. According to the American Society for Dermatologic Surgery, over 100 million laser and light source cosmetic procedures were performed by its members. Procedures including hair removal, nonablative treatments, as well as removal of pigmented lesions, tattoos, and unwanted vascular lesions have revolutionized this field. With an increasing number of physicians and nonphysicians performing these procedures, and with the availability of increasingly powerful laser technologies, the potential for problems and their legal consequences continue to increase. This chapter will deal with the concept of negligence and the potential for a resultant medical malpractice that may arise in such a setting. An understanding of the basic principles of a cause of action in medical malpractice will likely protect a physician from losing such a case in a court of law. [source]


A History of Dermatologic Surgery in the United States

DERMATOLOGIC SURGERY, Issue 1 2000
William P. Coleman III MD
Background. Dermatologic surgery has a long and distinguished history in the United States. Objective. To examine the specific contributions of American dermatologic surgeons. Method. The medical literature on cutaneous reconstructive and cosmetic surgery for the last century and a half was researched. Results. Numerous American dermatologic surgeons have had a major impact on scientific and technological discoveries in cutaneous surgery. Dermatologic surgeons have been significantly involved in cutaneous surgery since the second half of the 19th century. Dermatologic surgeons have contributed many important advances to the fields of chemical peeling, cryosurgery, dermabrasion, electrosurgery, hair transplantation, soft tissue augmentation, tumescent liposuction, laser surgery, phlebology, Mohs chemosurgery, cutaneous reconstruction, wound healing, botulium toxin, blepharoplasty, and rhytidectomy. Conclusion. Dermatologic surgeons in the United States have contributed significantly to the history of reconstructive and cosmetic surgery. Dermatologic surgeons have been leaders in advancing this field and are poised to continue in the future. [source]


Contribution of Dermatologic Surgery in War

DERMATOLOGIC SURGERY, Issue 1 2010
MAJOR J. SCOTT HENNING DO
BACKGROUND Despite the large contribution by dermatology to military readiness, there have been no published reports regarding dermatologic surgery or skin cancer in the combat environment. OBJECTIVE To outline the contribution of dermatologic surgery, including skin cancer and benign tumors, to deployed service men and women in Operation Iraqi Freedom. METHODS A retrospective chart review was performed of all dermatology visits at the 86th Combat Support Hospital, Ibn Sina, Iraq, between January 15, 2008 and July 15, 2008. RESULTS Two thousand six hundred ninety-six patients were seen in the combat dermatology clinic during the 6-month period reviewed; 8% (205/2,696) of the total visits were for skin cancer, and another 129 patients were treated for actinic keratosis. The specific diagnoses were basal cell carcinoma (n=70), in situ and invasive squamous cell carcinoma (n=68), mycosis fungoides (n=1), bowenoid papulosis (n=1), and in situ and invasive melanoma (n=9). Benign lesions and tumors accounted for 14% (357/2,696) of total patient visits. Three hundred seven surgeries were performed during the 6-month period (178 skin cancers and 129 benign lesions), and 20 patients were referred for Mohs micrographic surgery. The surgical complications included five postoperative wound infections (1 methicillin-resistant Staphylococcus aureus), one wound dehiscence, and seven allergic contact dermatitis. CONCLUSIONS To the authors' knowledge, this is the first publication regarding skin cancer and dermatologic surgery in the combat setting. This report outlines the important contribution of dermatologic surgery in the combat environment. The authors have indicated no significant interest with commercial supporters. [source]


Detecting Adverse Events in Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 1 2010
DANIEL PINNEY BS
BACKGROUND Despite increasing awareness of and public attention to patient safety, little is documented about how adverse events (AEs) can or should be monitored in dermatologic surgery. Data to address this shortcoming are needed, although well-defined methodologies have yet to be implemented. OBJECTIVE To summarize current strategies in detecting adverse outcomes of dermatologic surgical procedures. MATERIALS AND METHODS A Medline literature search was conducted using the terms "adverse event,""detection,""reporting,""monitoring," and "surgery." Articles selected addressed the efficacy of one or more AE reporting techniques in surgical patients. RESULTS Prospective and retrospective reporting methods were identified, with morbidity and mortality conference being the most commonly used method of AE reporting. Retrospective medical record review, the retrospective trigger tool approach, and an anonymous electronic reporting system were more sensitive approaches. The Surgical Quality Improvement Program, a program that has successfully translated AE data into lower postoperative morbidity and mortality, was analyzed. CONCLUSIONS Although generally considered safe, dermatologic surgery has no current standard for AE reporting. Standard definitions and high-quality data regarding AEs" currently limit this analysis. Pilot studies are needed to develop feasible measures, with the goal of increasing the sensitivity of AE detection and ultimately improving patient outcomes. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories. [source]


Recent Trends in Cosmetic and Surgical Procedure Volumes in Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 9 2009
EMILY P. TIERNEY MD
BACKGROUND The number of cosmetic and noncosmetic surgical procedures performed by dermatologic surgeons has been rising rapidly, but there are few consistent data sources allowing procedure volumes to be tracked over time. METHODS American Society for Dermatologic Surgery member survey in 2001 to 2007 reporting cosmetic and noncosmetic procedural volumes (300,500 surgeons surveyed, response rate of 31,44%). RESULTS In 2001, dermatologic surgeons performed an estimated 3.4 million cosmetic and noncosmetic surgical procedures; in 2007, it was estimated that a total of 7.6 million procedures were performed (120.2% rate of growth between 2001 and 2007). The procedures with the greatest increase during this time period were soft tissue augmentation (405.0% increase), botulinum toxin injections (324.4% increase), and nonablative skin rejuvenation (laser, light, and radiofrequency sources) (330.7% increase). More modest increases were noted in skin cancer procedures (85.8% increase) and ablative resurfacing procedures (66.8% increase). CONCLUSION The magnitude of growth in procedural volumes over the last 8 years reflects the advancements in dermatologic surgery in treatments for skin cancer and in treatment of photoaging and cosmetic enhancement of the skin. [source]


Photodynamic Therapy for the Treatment of Cutaneous Neoplasia, Inflammatory Disorders, and Photoaging

DERMATOLOGIC SURGERY, Issue 5 2009
EMILY TIERNEY MD
BACKGROUND Photodynamic therapy (PDT) has demonstrated high efficacy, minimal side effects, and improved cosmetic outcome when used for the treatment of actinic keratoses (AK), basal cell carcinoma (BCC), squamous cell carcinoma, and photoaging. METHODS To review the literature on the use of PDT in dermatologic surgery using MEDLINE. RESULTS Published clinical studies using PDT in the treatment of AKs yield overall efficacy rates ranging from 50% to 71% with one treatment to as high as 88% to 90% with two or more treatments. For superficial BCC, initial clearance rates were 76% to 97%, and for Bowen's disease, initial clearance rates ranged from 72% to 94% overall. The use of PDT for photorejuvenation is a relatively new application of this technology, which has shown promise in improving the appearance of fine lines, pigmentary variation, and telangiectasias. CONCLUSIONS The advantages of photodynamic therapy include the capacity for noninvasive targeted therapy through topical application of aminolevulinic acid and methyl aminolevulinic acid, with outstanding cosmetic results. Although the theory behind the use of chemical photosensitizers and ultraviolet light to treat a wide variety of skin disorders is straightforward, the practical application of this technology is evolving. Additional research into the precise mechanisms of action for specific photosensitizers and optimal light sources will be highly beneficial to the advancement of this technology. [source]


Recent Changes in the Workforce and Practice of Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 3 2009
EMILY P. TIERNEY MD
BACKGROUND The increasing number of American College of Mohs Surgery (ACMS) fellowship positions over the last decade has resulted in a greater number of fellowship-trained surgeons in dermatologic surgery. METHODS Mohs micrographic fellowship-trained surgeons (MMFTSs) and non-Mohs fellowship-trained surgeons performing Mohs micrographic surgery (NMMFTSs) were compared using the American Academy of Dermatology Practice Profile Survey (2002/05). An analysis of recent Mohs fellowship classes was also performed. RESULTS In 2005, there was an equivalent proportion of MMFTSs and NMMFTSs in the workforce (ratio MMFTS:NMMFTS=0.9) but, in 2005, there was a shift in the youngest age cohort (29,39) to a greater proportion of MMFTSs (MMFTS:NMMFTS=1.55). In 2005, the youngest MMFTSs (29,39) were more likely to be female (47.1%) than of MMFTSs overall (24%). MMFTSs were 5 times as likely to be in full-time academic positions and performed 2 to 3 times as many Mohs cases per week as NMMFTSs. CONCLUSIONS Consistent with demographic shifts in dermatology, differences have emerged in the demographics, surgical volumes, and settings of MMFTSs and NMMFTSs. Recent increases in the ACMS fellowship positions have resulted in a greater proportion of MMFTSs among younger dermatologic surgeons. It will be important to follow how this increase in fellowship trainees affects the dermatologic surgery workforce. [source]


Prevalence of Methicillin-Resistant Staphylococcus aureus in the Setting of Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 3 2009
ROGER S. SICA DO
BACKGROUND The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the postoperative setting of dermatologic surgery is unknown. Such data could influence the empirical treatment of suspected infections. OBJECTIVE To examine the period prevalence of MRSA infections in the postoperative setting of dermatologic surgery. METHODS We performed chart reviews of 70 patients who had bacterial cultures taken from January 2007 to December 2007. In the 21 postsurgical cases, we analyzed age, risk factors, sites of predilection, method of repair, and pathogen of growth. RESULTS The mean age of the overall study population was 57, with the mean age of postsurgical MRSA-positive cases being 75.5. Of the 21 postsurgical cultures taken, 16 cultures grew pathogen, and two of the 16 (13%) pathogen-positive cultures grew MRSA. LIMITATIONS This is a retrospective chart review of a relatively small sample size in one geographic location. Our patient population is known to contain a large number of retirees. CONCLUSION The increasing prevalence of MRSA skin and soft tissue infections and recommendation to modify empirical antibiotic therapy have been well documented in particular patient populations, but we caution against the empirical use of MRSA-sensitive antibiotics in the postoperative setting of dermatologic surgery. We advocate culturing all infectious lesions upon presentation and reserve empirical use of MRSA-sensitive antibiotics for high-risk patients or locations. [source]


Perioperative Management of von Willebrand Disease in Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 4 2007
AIMEE L. LEONARD MD
BACKGROUND Von Willebrand disease (VWD) is the most common inherited bleeding disorder, affecting an estimated 0.1% to 1% of the population. It is caused by a qualitative or quantitative defect of von Willebrand factor. Primary manifestations include intractable mucocutaneous bleeding after surgery or trauma. OBJECTIVE The objective was to review the pathophysiology and clinical features of VWD and to propose a perioperative management strategy for patients with this condition undergoing dermatologic surgery. METHODS AND MATERIALS Literature is reviewed. RESULTS The various types and clinical manifestations of this condition are reviewed, and a perioperative strategy is presented for managing patients with VWD who undergo cutaneous oncologic or cosmetic surgical procedures. CONCLUSIONS In most cases, dermatologic surgery can be safely performed in patients with VWD. The use of appropriate therapeutic prophylaxis in conjunction with a hematologist is indicated in high-risk, nonelective procedures. [source]


Warm and Neutral Tumescent Anesthetic Solutions Are Essential Factors for a Less Painful Injection

DERMATOLOGIC SURGERY, Issue 9 2006
CHIH-HSUN YANG MD
BACKGROUND Tumescent local anesthesia is widely used in dermatologic surgery. Minimizing pain associated with injections is crucial to successful surgical procedures. OBJECTIVE This study investigates the pain associated with warm and room temperatures in neutralized or nonneutralized tumescent anesthetic solutions injection. METHODS Thirty-six patients with axilla osmidrosis who underwent local anesthesia for surgery were randomly assigned to three groups. Group A received warm neutral (40°C) and room-temperature neutral (22°C) tumescent injections to each axillary region. Group B received warm neutral (pH 7.35) and warm nonneutral (pH 4.78) tumescent injections on each side of axilla. Group C received warm nonneutral and room-temperature nonneutral tumescent injections on each side of axilla. Pain associated with infiltration of anesthesia was rated on a visual analog scale (VAS). RESULTS A statistically significant decrease (p < .001) in pain sensation was reported on the warm, neutral injection side (mean rating, 32.7 mm) compared with the room-temperature, neutral injection side (mean rating, 53.3 mm). Patient-reported pain intensity was significantly lower on the side that received warm, neutral tumescent anesthesia (mean rating, 26.8 mm) than on the side receiving warm, nonneutral tumescent anesthesia (mean rating, 44.9 mm; p < .001). The difference in VAS scores between warm neutral (mean rating, 23.9 mm) and room-temperature nonneutral (mean rating, 61.2 mm) was statistically significant (p < .001). CONCLUSION The warm, neutral tumescent anesthetic preparation effectively suppressed patient pain during dermatologic surgical procedures. [source]


Advancement Flaps: A Basic Theme with Many Variations

DERMATOLOGIC SURGERY, Issue 2005
Ravi Krishnan MD
Background. The advancement flap involves the linear advancement of tissue in one direction. Despite its straightforwardness and simple concept, it can be used to close a variety of defects, ranging from small defects on the scalp or extremities to large, complicated defects involving cosmetic units on the face. Objectives. To provide a basic and useful review for the indications, advantages, disadvantages, and techniques for the use of advancement flaps in the reconstruction of defects in dermatologic surgery. Materials and Methods. We performed a literature search for articles discussing advancement flaps and compiled a brief review of our findings. Results. The movement of the advancement flap must be balanced by the blood supply of the flap. The excision of Burow's triangles along various aspects of the advancement flap can increase movement and improve cosmesis of the flap. The types of advancement flaps discussed include the single advancement flap, double advancement flap, A-T flap (O-T flap), Burow's triangle flap (Burow's wedge flap), crescenteric advancement flap, island pedicle flap (V-Y flap), helical rim advancement flap, and facelift flap. Conclusion. Advancement flaps are versatile and useful basic flaps for repairing defects. [source]


5-Aminolevulinic Acid Photodynamic Therapy: Where We Have Been and Where We Are Going

DERMATOLOGIC SURGERY, Issue 8 2004
Michael H. Gold MD
Background. Photodynamic therapy, utilizing the topical administration of 20% 5-aminolevulinic acid, has generated a great deal of interest in the dermatology community over the past several years. Objective. The purpose of this article is to review the history of photodynamic therapy in dermatology and to review recent new advances with this technology that will increase its appeal to all dermatologists. Methods. A literature review and results of new clinical trials with regards to photorejuvenation and acne vulgaris treatments with 5-aminolevulinic acid photodynamic therapy are presented. Results. Short-contact, full-face 5-aminolevulinic acid photodynamic therapy treatments with a variety of lasers and light sources have shown to be successful in treating all facets of photorejuvenation and the associated actinic keratoses as well as disorders of sebaceous glands, including acne vulgaris. The treatments are relatively pain-free, efficacious, and safe. They are also making already available laser/light source therapies work better for acne vulgaris and photorejuvenation. Conclusions. The use of 5-aminolevulinic acid photodynamic therapy with short-contact, full-face broad-application therapy is now able to bridge the world of medical and cosmetic dermatologic surgery. This therapy is available for all dermatologists to utilize in the care of their patients. [source]


Chemical Injury to the Eye from Trichloroacetic Acid

DERMATOLOGIC SURGERY, Issue 7 2002
Jason F. Fung MD
background. Trichloroacetic acid (TCA) is frequently utilized for chemical peeling by physicians practicing dermatologic surgery. Ocular complications from TCA have not been reported previously. objective. The purpose of this article is to underscore the irritating and corrosive effects of TCA on the eye. methods. A patient is described who experienced seepage of 35% TCA into the eye during a chemical peel. results. The patient developed marked conjunctivitis of the affected eye and abrasions involving 25% of the cornea. conclusion. TCA must be applied carefully around the eyes to avoid ocular complications, which albeit rare, can be quite grave if not addressed in a timely manner. [source]


The Impact of Herbal Medicines on Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 8 2001
Lawrence K. Chang MD
Background. In recent years herbal medicines and supplements have become increasingly popular. With their increased popularity, more publications are warning about the potential harmful effects of some of these products. Objective. To present scientific evidence of the benefits and surgical risks of herbal products. Methods. A Medline search and review of the literature was performed. Results. Many herbal medicines are relevant in dermatologic surgery since Ginkgo biloba, garlic, ginger, ginseng, feverfew, and vitamin E may increase the risk of bleeding, and ephedra may potentiate the side effects of epinephrine. Conclusion. Dermatologists should be aware of these herbal products and their uses. Many of these products prescribed by alternative medicine physicians or purchased over the counter should be discontinued prior to dermatologic surgery to minimize the risk of surgical complications. [source]


A Skin Surgery Fable

DERMATOLOGIC SURGERY, Issue 3 2001
Daniel A. Gross MD
A fable is presented to inform the reader of the existence of a valuable, but under-utilized educational resource that might be utilized in the teaching of dermatologic surgery. [source]


Wire Scalpel for Surgical Correction of Soft Tissue Contour Defects by Subcutaneous Dissection

DERMATOLOGIC SURGERY, Issue 2 2000
Marlen A. Sulamanidze MD
Background. Increasing demand exists for cosmetic correction of soft tissue contour defects. Treatments include simple tissue augmentation techniques or more complex surgeries with consequent relevant recuperation time for the patient. The search for new simple techniques to correct scars and age-related wrinkles and folds is therefore one of the main goals of cosmetic dermatologic surgery. Objective. To improve the cosmetic outcome of patients suffering from soft tissue contour defects by the use of a novel surgical instrument and technique, subcutaneous dissection by wire scalpel. Methods. Fifty-four patients were treated with the wire scalpel technique with no skin incisions to correct a total of 132 depressed cosmetic defects of the face. Forehead lines, glabellar, nasolabial and oral commissure folds, upper lip wrinkles, and acne scars were treated. A 2-month to 4-year follow-up allowed subjective and photographic evaluation of results. Results. Good or satisfactory results were obtained in 79.7% and 16.6% of the cases, respectively. Minor complications did not change the overall positive outcome of the surgery. Conclusion. Subcutaneous dissection by wire scalpel is a simple, safe, and effective method to improve the contour appearance of patients affected with scars or age-related contour defects. [source]