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Selected AbstractsPeriorbital Reconstruction with Adjacent-Tissue Skin GraftsDERMATOLOGIC SURGERY, Issue 12 2005Andrew J. Kaufman MD Background. Reconstruction in the periorbital area is challenging owing to the complex function of the eye, relative lack of adjacent loose tissue, free anatomic margin, central facial location, and the need to maintain symmetry with the contralateral eye. Reconstructive options risk crossing anatomic margins, deviation of the lid margin (ectropion), persistent lymphedema, and repair with skin of dissimilar color, texture, and thickness. Objective. The purpose was to describe a reconstructive option that would avoid crossing cosmetic units or subunits, minimize the risk of ectropion, repair with tissue of similar surface characteristics, and maintain function and symmetry with the contralateral side. Methods. The adjacent-tissue skin graft provides closure in cosmetic units and subunits, avoids tension on the lid margin, and provides similar skin for repair. The procedure is demonstrated by graphic and photographic examples. Results. The procedure provides for esthetic repair of the periorbital area and minimizes the risk of ectropion, lymphedema, asymmetry, and dysfunction of the lids and lacrimal system. Conclusion. Adjacent-tissue skin grafts are a useful alternative for reconstruction of partial-thickness defects on the eyelid and periorbital area. ANDREW J. KAUFMAN, MD, HAS INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Intraoral Extraction of Cheek Skin CystDERMATOLOGIC SURGERY, Issue 12 2005Richard Bennett MD Background. When a physician encounters a benign subcutaneous cyst in the cheek, his or her decision whether to excise and how to excise the cyst takes into account the potential risk of postsurgical scarring. Objective. To describe and show an intraoral buccal mucosal approach to excising a cyst in the inferior-anterior cheek so that skin scarring is avoided. Method. An incision was made intraorally in the buccal mucosa, and dissection was carried through the buccinator muscle until the cyst wall was seen. Careful separation of tissue around the cyst was done by blunt dissection, and the unruptured cyst was removed through the buccal mucosal incision. Result. The entire intact cyst was removed without creating any excision marks in the cheek skin. No complications were encountered, and buccal mucosal healing was excellent. Conclusion. A buccal mucosal intraoral approach is an alternative to a percutaneous excision to remove a cyst in the lower cheek region. The intraoral approach avoids a visible scar on the cheek skin. RICHARD BENNETT, MD, MUBA TAHER, MD, AND JUSTINE YUN, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Cryosurgery in the Treatment of Earlobe Keloids: Report of Seven CasesDERMATOLOGIC SURGERY, Issue 12 2005Tomas Fikrle MD Background. Keloids are benign cutaneous lesions that result from excessive collagen synthesis and deposition. Earlobe keloids in particular are seen as a complication of plastic surgery or piercing. Many different treatment modalities have been used, often with unsatisfactory results. Methods. We have made a retrospective analysis of seven young patients (ages 9 to 22 years) with earlobe keloids. Scarring followed plastic surgery in six cases and piercing in one case. All patients were treated with cryosurgery as the monotherapy. The freeze time and the number of sessions varied depending on the clinical findings, the effect of the treatment, and the patients' tolerance. Cryotherapy was started 6 to 24 months after keloid development. Results. Scar volume was reduced in all cases. Complete flattening in five patients and a pronounced reduction to a maximum of 25% of the previous thickness in one other patient were achieved. One patient discontinued the therapy because of soreness after only partial improvement. The procedure was painful for all patients; no further side effects were noticed. No recurrence was observed within 1 to 4.5 years of follow-up. Conclusion. We present an excellent effect of cryosurgery as the monotherapy for the treatment of earlobe keloid scars of young patients. TOMAS FIKRLE, MD, AND KAREL PIZINGER, MD, PHD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Squamous Cell Carcinoma of the Lower Lip: Exact Location Match in SiblingsDERMATOLOGIC SURGERY, Issue 12 2005Dogan Tuncali MD Background. In recent years, genetic contribution to the development of skin cancers is under the magnifying glass of several authors and is now regarded as the main initial etiology in carcinogenesis. Objective. Two siblings who had squamous cell carcinoma of the lower lip showing an exact location match are presented. Patients. They did not share common environmental factors, and there was no history of tobacco and/or alcohol abuse. Conclusions. It would be scientifically deceptive to draw generous conclusions for the cases here, other than being a very interesting and unusual coincidence, because further evaluation could not be done to scientifically prove a possible genetic contribution. DOGAN TUNCALI, MD, NURTEN YAVUZ, MD, AHMET TERZIOGLU, MD, AND GÜRCAN ASLAN, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Evaluation of the American Joint Committee on Cancer Staging System for Cutaneous Squamous Cell Carcinoma and Proposal of a New Staging SystemDERMATOLOGIC SURGERY, Issue 11 2005Scott M. Dinehart MD Purpose. To identify and propose corrections for deficiencies in the American Joint Committee on Cancer (AJCC) system for staging cutaneous squamous cell carcinoma (CSCC). Materials and Methods. Prognostic factors for CSCC were identified by retrospective analysis of the published literature. Limitations and deficiencies in the current AJCC staging system for CSCC were then determined using these prognostic factors. Results. Size, histologic differentiation, location, previous treatment, depth of invasion, tumor thickness, histologic subtype, perineural spread, and scar etiology are the most powerful tumor prognostic indicators in patients with localized disease. The most important prognostic factors for patients with nodal metastases are the location, number, and size of the positive lymph nodes. Proposed changes for the T classification include increased stratification of tumor size, identification of patients with perineural invasion, and the addition of tumor thickness or depth of invasion. The N classification has been expanded to include the number and size of nodal metastases. Conclusion. The current AJCC staging system for carcinoma of the skin has deficiencies that limit its use for CSCC. The proposed TMN staging system for CSCC more accurately reflects the prognosis and natural history of CSCC. SCOTT M. DINEHART, MD, AND STEVEN PETERSON, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Use of a Deep Polypropylene Suture during Earlobe Repair: A Method to Provide Permanent Reinforcement in the Prevention of Recurrent Earlobe Tract ElongationDERMATOLOGIC SURGERY, Issue 11 2005Joseph F. Greco MD Background. Cosmetic repair of elongated or lacerated earlobe tracts is a commonly encountered dermatologic procedure. For esthetic purposes, patients may choose to repierce the repaired lobe over the original site. Subsequent piercing within a scarred area potentially increases the risk of recurrent tract elongation secondary to the reduced tensile strength of the scar. Objective. To strengthen a damaged earlobe by incorporating a nonabsorbable, dermal polypropylene suture during earlobe repair. Methods. The technique is described within the text. Results. A deep polypropylene suture placed within a repaired earlobe tract provides a permanent barrier above which repiercing can be performed. Conclusion. Permanent reinforcement of the repaired earlobe serves to reduce the possibility of recurrent elongation of the earlobe tract. The technique is relevant when repeat piercing is desired over the original site. JOSEPH F. GRECO, MD, CHRISTINE S. STANKO, MD, AND STEVEN S. GREENBAUM, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Aggressive and Neglected Basal Cell CarcinomaDERMATOLOGIC SURGERY, Issue 11 2005Ali Asilian MD Background. Basal cell carcinoma (BCC) is the most common cutaneous malignancy and usually has a benign coarse. Rarely, examples of aggressive and neglected types of this tumor are seen. Objective. To present an interesting and dramatic example of how some people neglect their tumors and how devastating the sequelae can be. Methods. We report a 58-year-old man with an extensive BCC and signs of cranial nerve involvement. Results. The patient had a large, infected ulcer on his scalp. He also had skull bone destruction, osteomyelitis, mastoiditis, cranial nerve paralysis, and radiographic features of the skull base and upper cervical soft tissue involvement. Pathologic studies revealed an infiltrating form of BCC. Conclusions. If left untreated and neglected, as in this case, BCC can become inoperable and complicated. ALI ASILIAN, MD, AND BANAFSHE TAMIZIFAR, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Microcystic Adnexal Carcinoma Involving a Large Portion of the Face: When Is Surgery Not Reasonable?DERMATOLOGIC SURGERY, Issue 11 2005Daniel Brian Eisen MD Background. We report a case of microcystic adnexal carcinoma (MAC) involving a large portion of the face, one of the largest of any MAC reported thus far in this area, and review the literature regarding the nature of the tumor and available treatments. We also review all of the reported cases of metastases and the possible role of radiation in the etiopathogenesis of this tumor. Objective. To review the literature about what is known about therapy for MAC and what options are available to patients who have this disease. Materials and Methods. Case report and review of the literature. Results. Of the 274 cases of MAC thus far reported, there are 6 cases of metastases, only 1 of which resulted in death. Conclusion. Mohs surgery should be the treatment of choice for this tumor; however, when extirpation entails sufficiently large morbidity, given the low rate of metastases and mortality, observation is a reasonable alternative. DANIEL BRIAN EISEN, MD, AND DAVID ZLOTY, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Nonablative Laser Surgery for Pigmented SkinDERMATOLOGIC SURGERY, Issue 10 2005David J. Goldberg MD Background. Nonablative laser surgery has been proven to improve early photodamaged skin and acne scars. These techniques include treatments with lasers, light sources, and/or radiofrequency devices. Objectives. To review the history of nonablative technology and its applicability to darker skin types and to provide an objective look at the various published studies documenting the efficacy of nonablative technology. Conclusion. Nonablative laser surgery can improve skin quality and acne scars in all skin types. Complications are rare but can occur. Future studies are required to compare the efficacy of the various nonablative technologies. DAVID J. GOLDBERG, MD, HAS INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Relevance of Cosmeceuticals to the Dermatologic SurgeonDERMATOLOGIC SURGERY, Issue 2005Harold J. Brody MD Background. The dermatologic surgeon is the dermatologist with special expertise in the surgical care of the health and beauty of the skin. Objectives, Methods, Results. There is no better arena for the use of topical regimens to preserve skin quality than in the time interval devoted to before and after care with respect to surgical procedures. Conclusion. Many of these regimens can be tailor devised with topical drugs and cosmeceuticals together in proper balance in the patient's best interest for affordable health care. HAROLD J. BRODY, MD, HAS INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Botanical Extracts Used in the Treatment of CelluliteDERMATOLOGIC SURGERY, Issue 2005Doris Hexsel MD Background. Cellulite is defined as skin relief alterations that give the skin an orange peel or mattress appearance. The lesions tend to be asymptomatic and may be considered the anatomic expressions of the structures in the affected area, such as the fat and subcutaneous septa. Objective. The present article reviews the most important botanical extracts used as active ingredients in the treatment of cellulite, as well as the steps to obtain these botanicals as raw material and their standardization and quality control, which are important to guarantee their therapeutic action. Methods. The current literature was reviewed, and we also obtained information from the manufacturers of the prducts that contained botanicals because of the few publications about this subject. Conclusions. The reduction in fat deposits through the continuous use of anticellulite products depends on the availability of the active ingredient at the action site, the concentration of the ingredient in the formulation, and the physiochemical characteristics particular to each active ingredient. The botanicals used in topical products must have standardized extracts, which would permit each phytomedicine to have the same effect anywhere in the world. New scientific research is necessary to verify the efficacy and ideal concentrations of such substances. DORIS HEXSEL, MD, CECILIA ORLANDI, MD, AND DEBORA ZECHMEISTER DO PRADO, PHARM, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Cosmeceuticals Containing Herbs: Fact, Fiction, and FutureDERMATOLOGIC SURGERY, Issue 2005Carl Thornfeldt MD Background. Modern medicine is rooted in ethnobotanical traditions using indigenous flora to treat symptoms of human diseases or to improve specific aspects of the body condition. Herbal medicine is now used by over half of the American population. Yet the American medical community generally lacks knowledge of the function, metabolism, interaction, adverse reactions, and preparation of herbal products. Objective. Because over 60 botanicals are marketed in cosmeceutical formulations, dermatologists need to obtain working knowledge of the major botanicals. The preparation, traditional uses, mechanisms of action, human clinical data, adverse reactions, and interactions all impact herbal efficacy and are discussed below. Method. English-language medical journal and symposium searches. Results. The most important botanicals pertaining to dermatologic uses, such as cosmeceuticals, include teas, soy, pomegranate, date, grape seed, Pycnogenol, horse chestnut, German chamomile, curcumin, comfrey, allantoin, and aloe. All are documented to treat dermatologic conditions. Only green and black tea, soy, pomegranate, and date have published clinical trials for the treatment of parameters of extrinsic aging. Conclusions. Preparation of botanical-based cosmeceuticals is complex. Very few of these products are supported by evidence-based science. CARL THORNFELDT, MD, FAAD, HAS INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Histologic and Ultrastructural Analysis of Ultraviolet B Laser and Light Source Treatment of Leukoderma in Striae DistensaeDERMATOLOGIC SURGERY, Issue 4 2005David J. Goldberg MD Background. Lasers and light sources emitting ultraviolet B (UVB) irradiation have been shown to repigment striae distensae. Objective. The purpose of this study was to analyze the histologic and ultrastuctural changes seen after UVB laser, or light source,induced repigmentation of striae distensae. Methods. Ten subjects with hypopigmented striae were selected. Five subjects were treated with an XeCl excimer UVB laser, and five subjects were treated with a UVB light device. Six months after the final treatment, the biopsies were evaluated for both standard and electron microscopic changes in melanocytes. Results. Analyses of biopsied skin after treatment with both the UVB laser and light source showed increased melanin content, hypertrophy of melanocytes, and an increase in the number of melanocytes in all patients. Conclusions. Repigmentation of striae distensae with either a UVB laser or light source is due to an increase in melanin pigment, hypertrophy of melanocytes, and an increase in melanocytes. DAVID J. GOLDBERG, MD, ELLEN S. MARMUR, MD, CHRYSALINE SCHMULTS, MD, MUSSARRAT HUSSAIN, MD, AND ROBERT PHELPS, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Laser-Doppler Examination Shows High Flow in Some Common Telangiectasias of the Lower LimbDERMATOLOGIC SURGERY, Issue 4 2005Imre Bihari MD Background. The accepted pathophysiology of telangiectasias is reflux from superficial or deep veins. There are physical signs and scientific findings that do not fit this theory but support the possibility of arteriovenous (AV) shunt origin. Objective. If there is a higher flow in spider veins than in the surrounding skin, it means that AV shunts participate in the circulation of the telangiectasia. On the other hand, slow flow indicates reflux as the etiologic factor. Method. Telangiectasias and the surrounding skin of 22 legs of 19 patients were examined with laser-Doppler equipment. Results. The probe over the spider vein found a higher flow value (average 28.2 perfusion units [PU]) than in the surrounding skin (15.6 PU) in 13 limbs, but it was significantly higher only in 5 cases. In 9 limbs, the flow was slower. Conclusion. We interpret the higher flow values as a consequence of open AV shunts. This means that AV shunt pathophysiology was present in some of our cases. IMRE BIHARI, MD, PHD, ANIKÓ MURÁNYI, MD, AND PéTER BIHARI, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Nasalis Island Pedicle Flap in Nasal Ala ReconstructionDERMATOLOGIC SURGERY, Issue 4 2005Maryam Asgari MD Background. Defects of the nasal ala can be difficult to repair in a one-stage procedure. We describe a laterally based nasalis myocutaneous island pedicle flap to repair small but deep defects of the superior nasal ala. Objective. To describe a single-stage flap for repair of small defects on the nasal ala that confines the repair to one cosmetic unit. Methods. We discuss the anatomy of the flap and illustrate the method of placing the flap. Results. We present several case examples and discuss potential applications of the flap. We also discuss the flap's limitations by citing an example of necrosis. Conclusions. The nasalis myocutaneous island pedicle flap for repair of nasal alar defects is a new application of a one-stage procedure that yields excellent functional and cosmetic results. Knowledge of the limitations and the anatomy of the flap is crucial for a good outcome. MARYAM ASGARI, MD, MPH, AND PETER ODLAND, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] The Kerf-Cut Dressing: Application of a Woodworking Technique for Efficient Postsurgical Wound CareDERMATOLOGIC SURGERY, Issue 4 2005John Starling III BA Background. Simple surgical excision is one of the most common treatment methods in the dermatologist's armamentarium. We describe a precise postsurgical dressing technique that can be used for wound care of those patients whose treatment involves removal of lesions via cutaneous surgery. Objective. To devise a novel, precise, and effective dressing technique for postsurgical wound care. Materials and Methods. We describe the technique using common in-office instruments. Results and Conclusion. Wound dressings for lesions located on curved areas such as the ears, nose, cheeks, and chin often exhibit less than adequate adherence and stability. The kerf-cut dressing technique optimizes pliability of dressing tape, and this maximizes efficient and stable application of postsurgical wound dressings to curved areas of the body. JOHN STARLING III, BA, PURVISHA J. PATEL, MD, AND RON D. RASBERRY, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Imiquimod Treatment of Superficial and Nodular Basal Cell Carcinoma: 12-Week Open-Label TrialDERMATOLOGIC SURGERY, Issue 3 2005Ketty Peris MD Background Imiquimod is an immune response modifier shown to be effective in basal cell carcinoma (BCC). Objective To evaluate the efficacy, tolerability, and response durability of imiquimod 5% cream in selected patients with superficial and/or nodular BCCs. Methods Seventy-five superficial and 19 nodular BCCs in 49 patients were treated with imiquimod once daily three times a week for up to 12 weeks. Results Of the 49 enrolled patients, 1 discontinued the study and 1 was lost to follow-up. After 12 weeks of treatment, a complete response occurred in 70 of 75 (93.3%) superficial BCCs and a partial response in 4 of 75 (5.3%) superficial BCCs. Ten of 19 (52.6%) nodular BCCs cleared after 12 weeks, whereas 7 (36.8%) showed partial remission. Adverse side effects were limited to local skin reactions. Recurrence was observed in 2 of 70 (2.9%) successfully treated superficial BCCs 6 and 8 months after treatment discontinuation. No recurrence was detected in 68 of 70 (97.1%) superficial BCCs and in 10 successfully treated nodular BCCs after 12 to 34 months of follow-up (mean 23 months). Conclusions In our patient population, treatment of superficial BCCs with topical imiquimod for 12 weeks produced an excellent clinical response overall, with complete remission maintained after a mean of 23 months. KETTY PERIS, MD, ELENA CAMPIONE, MD, TAMARA MICANTONIO, MD, GEORGIANA CLARE MARULLI, MD, MARIA CONCETTA FARGNOLI, MD, AND SERGIO CHIMENTI, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Forehead Donor Site Full-Thickness Skin GraftDERMATOLOGIC SURGERY, Issue 3 2005Vassilios Dimitropoulos MD Background Full-thickness skin grafts (FTSGs) are useful for reconstructing nasal defects. Traditional reported donor sites include the preauricular, postauricular, supraclavicular, clavicular, conchal bowl, melolabial fold, and upper eyelid skin. Selection of the "best" donor site is based on the "best" tissue match and ability to camouflage the donor scar. Objective The purpose was to report our experience with FTSGs harvested from the forehead for reconstruction of nasal defects following Mohs' surgery. Methods A retrospective query of the Mohs' surgery database was performed to identify nasal defects repaired with a FTSG harvested from the forehead skin. The research record contained the patient age and gender, defect size, and cosmetic and functional outcomes interpreted by the patient and surgeon. Results FTSGs from forehead skin were used to repair the nasal defects in three patients. The functional and cosmetic outcome of all three cases was deemed excellent by the patient and surgeon. Donor site scars were well concealed within preexisting rhytids. Conclusion FTSGs harvested from the forehead, although limited in practical utility, may offer an optimal FTSG match for limited select defects while also providing an easily camouflaged donor site scar within a forehead rhytid. VASSILIOS DIMITROPOULOS, MD, CHRISTOPHER K. BICHAKJIAN, MD, AND TIMOTHY M. JOHNSON, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] A Case of Aptos Thread Migration and Partial ExpulsionDERMATOLOGIC SURGERY, Issue 3 2005José G. Silva-Siwady MD Background In our practice, the use of dented polypropylene suture has become a very simple, conservative, and effective procedure for lifting flabby ptosed facial tissue, improving it without surgery. As with some cosmetic procedures, we have seen complications with this technique. Objective To present a case report of migration and partial expulsion of Aptos thread (TOTAL Charm, Moscow, Russia). Methods After successful fixation of facial tissue with 10 Aptos threads (5 on each side, 3 in the upper and central cheek, and 2 in the mandibular area), the patient returned 28 days later owing to migration and partial expulsion of one of the Aptos threads. Results The expulsed thread was easily removed, and the patient was treated with antibiotic therapy without further complications. Conclusion After this experience, we can conclude that Aptos threads are an additional tool in our arsenal for the treatment of facial aging. We must be especially cautious and aware that our patients can present with previously unknown complications secondary to newly described procedures, as with this recent technique. JOSé G. SILVA-SIWADY, MD, CELINA DÍAZ-GARZA, AND JORGE OCAMPO-CANDIANI, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Nail Biopsy: Assessment of Indications and OutcomeDERMATOLOGIC SURGERY, Issue 2 2005Chander Grover MD, MNAMS Background For years, nail biopsy has been shunned as a difficult and scarring procedure, which is seldom required in day-to-day practice. Only a few studies with a limited number of patients have been carried out to assess its utility in dermatology. Methods We studied 270 patients with nail disorders (both infectious and noninfectious). In 205 cases, the clinical diagnosis could be confirmed with the help of routine diagnostic aids, in the form of potassium hydroxide preparation, fungal culture, and biopsy of associated skin lesions. In the remaining 65 cases, various types of nail biopsies were carried out after ruling out contraindications to nail surgery. Results Overall, the histopathologic changes were found to be diagnostic in 63% of cases. Findings were more characteristic in infectious disorders of the nail unit. The diagnostic yield varied with the type of biopsy procedure. Side effects in the form of scarring and nail dystrophy were seen in 29.2% of the patients. Discussion Nail biopsy is useful, especially in cases with isolated nail involvement, an absence of skin lesions, and disorders such as twenty-nail dystrophy. It should be advocated in cases in which the routine diagnostic procedures fail to yield results. Proper selection of cases, choice of biopsy technique, and attention to the surgical procedure help in minimizing the side effects associated with the procedure. Conclusion Nail biopsy was found to be a simple, safe, and useful procedure, especially in cases in which the clinical diagnosis is otherwise obscure. CHANDER GROVER, MD, DNB, MNAMS, SONI NANDA, MD, B. S. N. REDDY, MD, MNAMS, AND KRISHNAMOORTHY UMA CHATURVEDI, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPPORTERS. [source] Pemphigus Foliaceus Masquerading as Postoperative Wound Infection: Report of a Case and Review of the Koebner and Related Phenomenon following Surgical ProceduresDERMATOLOGIC SURGERY, Issue 2 2005Adam M. Rotunda MD Background The Koebner phenomenon, also known as the isomorphic response, is the development of preexisting skin disease following trauma to uninvolved skin. Various cutaneous disorders have been described to arise at surgical wounds and scars. Moreover, dermatologic procedures, such as cold-steel and laser surgery, can evoke koebnerization. Objective To describe a case of pemphigus foliaceus arising in postoperative wounds and to present a review of dermatologic disorders triggered by surgical procedures. Methods We report a case of pemphigus foliaceus initially presenting at sites of Mohs' micrographic surgery, shave biopsy, and cryotherapy and, subsequently, at a nonsurgical site. We reviewed the English literature in MEDLINE from November 1955 to April 2004 for reports of Koebner and related phenomenon following surgical procedures. Results To our knowledge, this is the first reported case of pemphigus foliaceus erupting at surgical and cryotherapy wounds. The clinical appearance can mimic wound infection. In addition to inducing preexisting disease, cutaneous procedures can also trigger the onset of new disease, which can either be limited only to the surgical site or subsequently become generalized. Conclusion Postoperative Koebner or related responses should be included in the differential diagnosis of poorly healing surgical wounds. Skin biopsies for histopathology and immunologic studies may be necessary for definitive diagnosis and optimal management. ADAM M. ROTUNDA, MD, ANAND R. BHUPATHY, DO, ROBERT DYE, MD, AND TERESA T. SORIANO, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Angiokeratoma Circumscriptum Naeviforme: Successful Treatment with Carbon-Dioxide Laser VaporizationDERMATOLOGIC SURGERY, Issue 2 2005Jesús del Pozo MD Background Angiokeratoma circumscriptum naeviforme (ACN) is an unusual type of localized angiokeratoma that occurs more frequently in females and is usually located on the buttocks or thighs, showing a unilateral distribution. ACN usually causes large lesions, which may require laser ablation because they often are too extensive to perform surgical excision. Carbon-dioxide laser is a known alternative for treating angiokeratomas. Objective Report of two cases of ACN treated with carbon-dioxide laser vaporization. Patients and methods A 28-year-old woman with a hyperkeratotic, violaceus plaque on her left buttock and a 24-year-old woman with a similar lesion on her right buttock were treated with a carbon-dioxide laser. Two laser passes were performed on each lesion within a single session. Results A successful cosmetic aspect of treated areas was obtained, with minimal pigmentary or textural changes. After a 2-year follow-up in the first patient and a 6-month follow-up in the second patient, no recurrence of the lesions was observed. Conclusions Our results, obtaining relevant cosmetic improvement after a few sessions of treatment, with low morbidity and minimal secondary effects, suggest that continuous-wave carbon-dioxide laser vaporization is a safe and effective treatment for ACN. JESÚS DEL POZO, MD, AND EDUARDO FONSECA, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Curettage prior to Mohs' Micrographic Surgery for Previously Biopsied Nonmelanoma Skin Cancers: What Are We Curetting?DERMATOLOGIC SURGERY, Issue 1 2005Comparative Study, Prospective, Retrospective Background Curettage prior to excision and Mohs' micrographic surgery for nonmelanoma skin cancer is performed based on the assumption that the curette will remove softer, more friable tumor-infiltrated dermis and leave structurally intact normal skin. This assumption, however, has not been objectively examined in the dermatologic surgery literature. Objective We performed a study to examine the ability of curettage to selectively remove and delineate nonmelanoma skin cancer prior to Mohs' micrographic surgery. Methods The study included 150 previously biopsied basal cell and squamous cell carcinomas less than 1.5 cm in size. We conducted (1) a retrospective study of 50 tumors curetted prior to Mohs' surgery by a surgeon who routinely curettes preoperatively; (2) a prospective study in which a surgeon who routinely does not curette preoperatively curetted 50 tumors prior to Mohs' surgery; and (3) a comparative historical group of 50 noncuretted tumors treated with Mohs' surgery by the latter surgeon. All curetted tissue was evaluated histologically. Results Only 50% of the curetted tissue demonstrated the presence of tumor in the curettings, but in 76% of these, the curette left residual tumor at the surgical margins. Of the other 50% in which the curette removed only non,cancer-containing skin, 34% had tumor present at the surgical margin. Overall, the curette removed tumor, leaving no residual tumor at the surgical margins in only 12% of lesions. Comparison with historical noncuretted tumors operated on by the same surgeon showed that curettage did not affect the mean number of stages or the proportion of tumors requiring more than one stage for histologic clearance. Conclusion Although curettage may be helpful in debulking friable skin prior to Mohs' micrographic surgery, it does not reliably delineate the extent of a tumor. MING H. JIH, MD, PHD, PAUL M. FRIEDMAN, MD, LEONARD H. GOLDBERG, MD, AND ARASH KIMYAI-ASADI, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Minimal-Scar Segmental Extraction of Lipomas: Study of 122 Consecutive ProceduresDERMATOLOGIC SURGERY, Issue 1 2005Rajiv Y. Chandawarkar MD Background Surgical extirpation of lipomas that occur in cosmetically conspicuous areas of the body leaves a visible scar that is usually disfiguring. Minimal-scar segmental extraction (MSE) employs a much smaller incision and extraction and is particularly useful in exposed parts of the body. It can be easily performed in an office setting. Objective The objective of this study was to evaluate the merits of MSE in clinical practice. Unlike other reports in the literature that describe, anecdotally, minimally invasive methods of lipoma removal, our study examined a new method by carefully measuring the results in a larger group of consecutive patients treated using this technique. Materials and Methods A retrospective study was performed using data from 91 consecutive patients with a total of 122 lipomas that were treated using MSE. MSE of lipomas consists of a small stab incision and blind dissection of the tumor followed by its extraction in a segmental fashion. This procedure involves small instrumentation, minimal dissection with preservation of contour, and complete removal of the lipoma, including substantial portions of the capsule. Clinical data, including complications, outcomes, and recurrence rates, were recorded. Results The procedure was well tolerated by patients, who were pleased with the results, particularly the small scar. The incidence of complications was 1.6% (n= 2) and consisted of hematoma (n= 1) and seroma (n= 1). The recurrence rate was 0.8% (n= 1). No long-term morbidity was noted. Conclusions The technical ease with which the MSE can be performed, coupled with a low recurrence rate, makes it a very cost-effective operation. The smaller postoperative scars, rapid healing, and low morbidity allow for better patient acceptance. We recognize the advantages and limitations of this procedure and encourage its use in selected patients. RAJIV Y. CHANDAWARKAR, MD, PEDRO RODRIGUEZ, MD, JOHN ROUSSALIS, MD, AND M. DEVIPRASAD TANTRI, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Upper Eyelid Full-Thickness Skin Graft in Facial ReconstructionDERMATOLOGIC SURGERY, Issue 1 2005Dogan Tuncali MD Background The potentially available upper eyelid skin, as an alternative donor site, deserves more attention in clinical use. Objective The objective of this study was to prospectively evaluate the clinical behavioral characteristics of upper eyelid full-thickness skin grafts in facial reconstruction. Methods Sixteen patients who concluded the 12-month follow-up period were included in the study. Graft dimensions were measured in place before the graft harvest. Defect sizes were measured following lesion excision and postgrafting. Graft sizes were measured postoperatively at 1, 3, 6, and 12 months. Results The largest and smallest grafts were 46 × 22 mm and 40 × 15 mm (average 43.1 × 19.3 mm) in size, respectively. The largest and smallest defect dimensions were 33 × 23 mm and 17 × 9 mm (average 22.6 × 15.6 mm), respectively. The average postgrafting size was 21.1 × 14.6 mm. Grafts and donor sites healed very well. Generally, an acceptable to good texture and color match was observed beyond 6 months. Wound bed contraction was not observed beyond the first month (p < .05). Conclusion Special characteristics of hairless skin, good color and texture matching, and inconspicuous and hidden donor scar make the upper eyelid a good alternative donor site for small- to medium-sized facial skin defects. The main disadvantages that limit its clinical use are the age of the patient, a lack of adnexal structures, comparatively limited sun exposure, and possible insufficient thickness, especially when deep defects are of concern. DOGAN TUNCALI, MD, LEVENT ATES, MD, AND GÜRCAN ASLAN, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] A methodology for simulating power system vulnerability to cascading failures in the steady stateEUROPEAN TRANSACTIONS ON ELECTRICAL POWER, Issue 8 2008Murali Kumbale Abstract Simulations of power system conditions and event sequences leading to either local or widespread blackout has acquired increasing importance following wide-impact network collapses that have occurred over the past several years in North America and Europe. This paper summarizes an analytical framework that has been developed, implemented, and practically used by Southern Company to evaluate system vulnerability to cascading failures using the steady state model. This methodology was first used by Southern Company in 1999. The studies performed at Southern Company have already influenced and motivated certain transmission development projects. Future improvements to the method could include better modeling and sequencing of cascading steps, including time sequence of failures using equipment response time. Significant interest exists in developing preventive methods and procedures and in the application of this technology in the infrastructure security arena. Copyright © 2008 John Wiley & Sons, Ltd. [source] On the Time-Resolved Optogalvanic Spectra of Neon and KryptonCONTRIBUTIONS TO PLASMA PHYSICS, Issue 6 2007N. K. Piracha Abstract In this work time resolved optogalvanic signals associated with transitions excited from the first metastable state of neon and krypton have been studied. These gases have similar energy state configurations and it is of significant interest to study their time resolved optogalvanic waveforms resulting from transitions belonging to the states of same quantum numbers. The experimentally observed optogalvanic signals recorded for different discharge currents have been fitted to a theoretical model to obtain parameters that determine amplitudes, instrumental time constants and decay rates of the 1s levels. (© 2007 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Digital Block With and Without Epinephrine During Chemical Matricectomy with PhenolDERMATOLOGIC SURGERY, Issue 10 2010H. CEVDET ALTINYAZAR MD BACKGROUND Digital block with epinephrine is safe in selected patients. Chemical matricectomy with phenol is a successful, cheap, and easy method for the treatment of ingrown nails. OBJECTIVE To determine the effect of digital block with epinephrine in chemical matricectomy with phenol. MATERIAL AND METHODS Forty-four patients with ingrown toenail were randomly divided into two groups. The plain lidocaine group (n=22) underwent digital anesthesia using 2% plain lidocaine, and the lidocaine with epinephrine group (n=22) underwent digital anesthesia with 2% lidocaine with 1:100,000 epinephrine. In the postoperative period, the patients were evaluated for pain, drainage, and peripheral tissue destruction and were followed for up to 18 months for recurrence. RESULTS The mean anesthetic volume used in the epinephrine group (2.2±0.4 mL) was significantly lower than the plain lidocaine group (3.1±0.6 mL). There was no statistically significant difference in postoperative pain and recurrence rates, but duration of drainage was significantly shorter in the epinephrine group (11.1±2.5 days) than in the plain lidocaine group (19.0±3.8 days). CONCLUSION Digital block with epinephrine is safe in selected patients, and epinephrine helps to shorten the postoperative drainage period. The authors have indicated no significant interest with commercial supporters. [source] Commentary: Chemical Matricectomy of NailsDERMATOLOGIC SURGERY, Issue 10 2010LEONARD H. GOLDBERG MD Leonard H. Goldberg, MD, FRCP, has indicated no significant interest with commercial supporters. [source] Multiple V-Y Advancement and Rotation Flaps for a Large Cheek DefectDERMATOLOGIC SURGERY, Issue 10 2010RAMESH KUMAR SHARMA MCh The authors have indicated no significant interest with commercial supporters. [source] | |||||||||||||||||||||||||