Dermatologic Surgery最新文献

Background: Congenital earlobe clefts, particularly the defective type with severe tissue deficiency, present unique reconstructive challenges requiring specialized techniques.

Objective: To evaluate the efficacy and safety of a preformed, inverted, and anastomosed subauricular tongue-shaped flap technique for treating defective-type congenital earlobe clefts.

Materials and methods: Twenty patients (12 male and 8 female patients; aged 8-34 years) with unilateral defective-type congenital earlobe clefts underwent surgical correction using a tongue-shaped flap from the subauricular region. Outcomes were evaluated using a 15-point scoring system by 2 independent surgeons.

Results: The mean assessment score was 13.4 (range: 10-15), with substantial interrater reliability (κ = 0.85). Eighteen patients (90%) achieved good outcomes, whereas 2 (10%) had fair outcomes. Minor complications occurred in 2 patients (10%). Patient satisfaction was high, with 85% reporting being "very satisfied" with overall appearance.

Conclusion: The preformed, inverted, and anastomosed subauricular tongue-shaped flap technique provides a reliable method for repairing defective-type congenital earlobe clefts, offering natural appearance and minimal scarring.

Background: The current Micrographic Surgery and Dermatologic Oncology (MSDO) fellowship match process requires applicants and fellowship directors to rank each other with limited information. Fellowship directors receive standardized information about applicants, but applicants lack comparable program data.

Objective: To determine how MSDO applicants learn about fellowship programs, and what program characteristics influence their rank list decisions.

Materials and methods: All MSDO applicants to the University of Pennsylvania for the 2025 to 2026 fellowship year were invited to participate in a web-based survey distributed via email. The survey evaluated applicant characteristics, preferred information sources to learn about programs, program characteristics impacting applicants rank list, and which applicant achievements and personal characteristics they believed fellowship directors valued most. Data collection concluded when 20% of the estimated 2024 national MSDO applicant pool responded.

Results: This survey analyzed responses from 39 MSDO applicants (26% of the estimated national applicant pool). Applicants primarily relied on interviews (84.6%), program websites (82.0%), and mentors (71.8%) for information. The most valued program characteristics were clinical autonomy, complex case volume, and prior fellows' satisfaction.

Conclusion: Fellowship directors can improve match outcomes by providing clear, standardized information through program websites, structured interviews, and details on clinical training, case complexity, and fellow autonomy.

Background: Androgenetic alopecia (AGA) is the leading cause of patterned hair loss. Current therapies are limited, and injectable therapy has emerged for intradermal delivery of bioactive agents. Despite increasing use, protocols and outcomes remain heterogeneous.

Objective: To systematically evaluate the agents, techniques, efficacy, and adverse effects of injectable therapy for AGA.

Materials and methods: A systematic review was conducted in July 2025 following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, Embase, and Scopus were searched using the terms "mesotherapy" and "AGA." Studies were screened for relevance, with 30 meeting inclusion criteria.

Results: Included studies comprised 7 interventional, 11 observational, and 12 descriptive reports. The most frequently studied agents were multivitamin and peptide formulations, followed by dutasteride, minoxidil, bicalutamide, growth factors, and finasteride. Techniques varied in needle type, depth, and dosing schedules. Reported outcomes ranged from increased hair density and shaft diameter to stabilization of shedding. Adverse events were generally mild but included paradoxical alopecia, scarring, and acute dermatitis.

Conclusion: Injectable therapy may provide cosmetic benefit in AGA, particularly with dutasteride, but current evidence is limited by small sample sizes, variable protocols, and short follow-up. Standardized randomized trials are required before injectable therapy can be recommended as routine therapy.

Background: As yet, there is no functional focal reverser for the adverse effects of cosmetic botulinum toxin injections.

Objective: The authors report the first Phase 1 study in human subjects of local administration of an anticholinesterase for reversing muscle weakness, which may result from these neurotoxin-induced complications.

Materials and methods: An anticholinesterase, or cholinesterase inhibitor, indicated for reversal of neuromuscular blockage in anesthesia, was injected into the same 5 injection sites as were used for the cosmetic onabotulinum toxinA, glabellar treatment.

Results: In most patients treated with the reversal agent under investigation, there was a notable recovery of cosmetic blockade; no subject treated with placebo demonstrated a reversal response. Evidence of reversal became evident within the first 15 minutes after injection of the study drug, with no major or persistent adverse events.

Conclusion: Proof of concept, feasibility, and safety of local neuromodulator reversal are now shown; however, further studies are required to optimize dosage, distribution, and formulation.

Background: There is a paucity of literature investigating the use of liposomal bupivacaine (LB) in a dermatologic surgery setting.

Objective: To identify the treatment characteristics and adverse events, including Local Anesthetic System Toxicity (LAST), in patients receiving perioperative LB.

Materials and methods: A retrospective chart review was performed at a single institution using an institutional database and key words "Exparel" or "liposomal bupivacaine." Patients ≥18 years old who received perioperative LB to the surgical site and surrounding skin were included.

Results: A total of 140 LB administrations and 129 patients were included. Liposomal bupivacaine was used most often in the setting of excisions (n = 88, 62.9%) and Mohs micrographic surgery (n = 49, 35%), with hidradenitis suppurativa (n = 77, 55%) and cutaneous neoplasms (n = 56, 40%) the most frequent diagnoses. The median postoperative area and length were 23.6 cm2 and 15.4 cm, respectively. The median LB dosage was 20 mL (range 1.5-20). There were no adverse events in 134 out of 136 patients of LB administration (98.5%). There were 2 reports (1.5%) of nausea on POD1 while these patients were taking opioids.

Conclusion: Liposomal bupivacaine should be considered for postoperative analgesia in patients undergoing dermatologic surgery because it is well tolerated and efficacious. The authors observed no cases of LAST.