Dermatologic Surgery最新文献

Background: Flap repair provides unique advantages in facial reconstruction but still carries the potential for undesirable postoperative cosmetic changes.

Objective: The aims of this study were to describe postoperative vascular outcomes of patients undergoing flap repairs after Mohs micrographic surgery on facial tumors and to assess associations of baseline characteristics with outcomes.

Materials and methods: In this study, 7 dermatologists and 1 physician assistant in dermatology assessed preoperative and postoperative photographs of 57 patients who underwent facial Mohs micrographic surgery, evaluating vascular and pigment outcomes and number of telangiectasias.

Results: There was a significant difference in number of telangiectasias according to body location ( p = .002), where the number of telangiectasias was highest for nose surgery.

Conclusion: These data suggest that nasal flap repairs are associated with increased postoperative vascular changes. This highlights an opportunity for improved preoperative patient counseling and possible early laser treatment after nasal Mohs micrographic surgery.

Background: Tranexamic acid (TXA) is an antifibrinolytic that has historically been used to treat menorrhagia and bleeding disorders. Exploration of its use in procedures has grown, and it has shown promise in its ability to achieve hemostasis with low risk to patients. Analysis of its use in Mohs micrographic surgery (MMS) is warranted due to its potential superiority to traditional methods of achieving hemostasis (direct pressure, electrocoagulation, and sutures).

Objective: To perform a systematic review of studies which evaluate the efficacy and safety profile of topical application or subcutaneous injection of TXA and analyze as it applies to MMS.

Materials and methods: A comprehensive literature search was conducted using the PubMed database to identify relevant studies using the search terms: "tranexamic acid" OR "TXA." The search was performed up to December 1, 2023.

Results: Tranexamic acid has a strong safety profile, and its effectiveness in achieving hemostasis is well-demonstrated. Tranexamic acid has reduced risk of bleeding complications compared with traditional methods of achieving hemostasis.

Conclusion: An extensive review of the literature has yielded positive results, suggesting the potential of TXA in improving patient outcomes, reducing surgical time, decreasing intraoperative and postoperative bleeding, and increasing overall patient satisfaction.

Background: Although lidocaine is widely used in dermatologic surgery, no formal standard concentration is established. Previous research indicates that more dilute concentrations may offer equally effective anesthesia while potentially reducing toxicity risks. In addition, diluting commercially available lidocaine conserves supplies-a significant benefit during periods of lidocaine shortage.

Objective: To evaluate the efficacy of 0.25% lidocaine compared with that of 0.5% lidocaine in achieving anesthesia in cutaneous surgery.

Materials and methods: A prospective, double-blind study with 100 patients undergoing cutaneous surgery (Mohs surgery or excision) randomized to receive either 0.25% or 0.5% lidocaine for their percutaneous anesthesia. Patients completed a postoperative survey assessing pain level, satisfaction, and willingness to undergo future dermatologic surgery.

Results: This study revealed no statistically significant differences between the 0.25% and 0.5% lidocaine groups regarding pain scores, patient satisfaction, total lidocaine volume, rescue lidocaine volume, or willingness to undergo the procedure again.

Conclusion: 0.25% lidocaine is a safe and effective option for achieving anesthesia during Mohs surgery and standard excisions. The results suggest that 0.25% lidocaine can be used to optimize high-value care and enhance patient safety in dermatologic surgery.

Background: There is very little legislation defining the degree of supervision and training required to perform cosmetic procedures in Missouri. The medical spa industry, particularly the volume and complexity of cosmetic procedures offered by medical spas, has seen significant growth in recent years.

Objective: To better understand the medical spa workforce, depth, and breadth of aesthetic procedures offered by medical spas in Missouri.

Materials and methods: Cross-sectional study based on standardized telephone interviews, supplemented by website data. Survey responses were recorded, streamlined, and analyzed.

Results: Although 94.59% of medical spas in Missouri are affiliated with a physician, only 22.52% of medical spas have a physician on-site for administration of cosmetic treatments. Nonphysician staff members who administer cosmetic services generally outnumber physician affiliates at Missouri medical spas, with the average ratio of nonphysician staff who administer cosmetic services to MD/DO affiliates per spa being 2.1:1.

Conclusion: There is significant variability in the level of training and supervision of medical spa staff performing cosmetic treatments in Missouri. As the medical spa industry continues to grow and high-risk cosmetic procedures become more commonplace, consistent statewide regulation of medical spas is needed to prevent harmful patient outcomes.