Dermatologic Surgery最新文献

Background: Age-related volume loss in the temple results in a hollow and aged appearance. Although dermal fillers are commonly used for correction, the proximity of important blood vessels in this area increases the risk of complications.

Objective: To evaluate the vascular anatomy of the temporal region using microvascular imaging and assess its implications for anatomical planning of filler injection.

Materials and methods: Microvascular imaging was used to visualize the superficial temporal artery in 62 patients and the deep temporal artery in 56 patients. Arterial depth was measured and analyzed in relation to age, gender, and body mass index. Measurement consistency was assessed using intraclass correlation analysis.

Results: Lower-body mass index and younger age correlated with thinner soft tissue. In some cases, the deep temporal artery was 0.3 millimeters from bone, and the superficial temporal artery 1.15 millimeters from skin. Measurements showed excellent interobserver agreement. No other significant associations were found.

Conclusion: The authors' findings demonstrate that superficial and deep temporal arteries may run at variable depths, sometimes close to the skin or periosteum. These variations should be considered in planning temple filler injections. Microvascular imaging may assist in visualizing these vessels and identifying higher-risk zones.

Background: Dermatologic surgery generates considerable medical waste due to its high procedural volume, yet specialty-specific guidance on sustainable practices remains limited.

Objective: To present an evidence-based framework for reducing waste in dermatologic surgery while maintaining safety and efficacy.

Materials and methods: A comprehensive search of PubMed was conducted for articles published from 2000 onward using key terms combining predefined waste reducing interventions (e.g. multipack nonsterile gloves, reusable drapes and instruments, longer-acting anesthetics, continuous suturing, simplified dressings) with ("waste reduction" OR "sustainability"). Evidence was graded by Oxford CEBM (1a-5) and GRADE (A-D).

Results: Twenty-eight sustainability strategies were identified across the preoperative, intraoperative, and postoperative phases of dermatologic surgery, 15 of which were supported by level 1 to 2 evidence. High-level interventions included the use of nonsterile gloves, longer-acting anesthetics, reusable drapes and instruments, absorbable and continuous suturing techniques, and occlusive dressings.

Conclusion: This review summarizes evidence-based sustainability strategies shown to reduce environmental impact and provides a practical framework for potential implementation in dermatologic surgery.

Background: Dermatofibrosarcoma protuberans (DFSP) arising in the vulvar and perivulvar region poses unique challenges to the dermatologic surgeon. The potential for broad subclinical extension and involvement of deeper and high-risk functional structures requires a strong knowledge of relevant anatomy. Careful considerations are required for preoperative arrangements, surgical day preparations, and postoperative surveillance to improve treatment outcomes and patient experiences.

Objective: The authors aim to provide a practical guide for the dermatologic surgeon, which outlines surgical planning and management recommendations for vulvar DFSP. Emphasis on pelvic anatomy through cadaveric and patient images as well as anatomical illustrations will be included.

Materials and methods: A literature review was performed to identify evidence-based management recommendations for vulvar DFSP. Authors share anecdotal perioperative recommendations for optimizing the patient experience. A detailed pelvic dissection of a female cadaver was performed for anatomical depiction of relevant high-risk structures. Illustrations of sensory nerve distributions were created for reference.

Conclusion: Vulvar DFSP is a challenging cutaneous tumor in a sensitive anatomical location. As Mohs surgery offers clear advantages over wide local excision, the authors provide dermatologic surgeons with detailed anatomy review resources as well as recommendations and considerations for management and perioperative planning for this specialized site.

Background: Patient nonadherence is a leading cause of treatment failure, suboptimal outcomes, and increased health care utilization. Adherence is also suboptimal in dermatologic surgery and Mohs micrographic surgery (MMS), despite playing a vital role in the surgical outcome. Poor adherence may lead to untreated skin cancers, complications such as flap or graft necrosis, and low patient satisfaction due to inferior cosmesis.

Objective: To outline targeted, practical interventions, the dermatologic surgeon can implement to improve outcomes in patients at risk for poor adherence.

Materials and methods: Searches of MEDLINE and Scopus were conducted using a search strategy to identify articles discussing adherence and dermatologic surgery. Articles were assessed for level of evidence, and recommendations were assigned a grade according to the system outlined by the Oxford Centre for Evidence-Based Medicine.

Results: Thirty-six interventions-using evidence-based behavioral principles such as anchoring, salience, and "white coat compliance"-to improve patient adherence in the preoperative, intraoperative, and postoperative settings are described.

Conclusion: Poor patient adherence is common in dermatologic surgery, and MMS and can lead to surgical complications and suboptimal outcomes. Understanding the scope and reasons for poor adherence may allow the dermatologic surgeon to assess adherence, determine the rationale for nonadherence, and implement practical interventions to optimize adherence.