Dermatologic Surgery最新文献

Background: When performing Mohs micrographic and dermatologic surgery for high-risk cutaneous malignancies, particularly aggressive scalp tumors, there may be positive or indeterminate deep margins overlying clinically uninvolved bony cortex (outer table).

Objective: To ensure complete tumor extirpation in these situations, the authors performed superficial bone decortication and report their case series.

Methods: Over six consecutive months, superficial bone decortication was performed using a microdrill with rosehead bur after 10 Mohs micrographic surgery cases and one incomplete skin cancer excision. Cases included eight squamous cell carcinomas, two pleomorphic dermal sarcomas, and one basal cell carcinoma. The mean preoperative largest tumor diameter was 37.2 mm, and the mean postoperative largest defect diameter was 49.4 mm. Patients completed mixed-methods questionnaire with a Likert scale, dichotomous, and open-questions.

Results: The median pain value was 0 (mean 0.4) during the decortication surgery. All patients receiving Mohs surgery preferred superficial bone decortication under local anesthetic on the day of Mohs rather than referral for another day under general anesthetic.Analysis of open questions determined the procedure was similar to dental drilling -noisy with a vibratory sensation but caused little discomfort.

Conclusion: Superficial bone decortication is a well-tolerated and safe procedure in an outpatient setting and can be readily performed after Mohs micrographic surgery in clinically uninvolved bone.

Background: Noncultured melanocyte keratinocyte transplantation (MKTP) is an important therapeutic modality for therapy-resistant stable vitiligo. Perigraft halo (PGH) commonly occurs after MKTP but studies tackling PGH are limited.

Objective: To characterize PGH after MKTP for vitiligo and identify some risk factors.

Methods: This was a retrospective study of patients with stable vitiligo who underwent MKTP. PGH was defined as the presence of white rim at the periphery of the treated lesion 3 months after surgery. Multivariate logistic regression analysis was conducted to identify independent factors associated with PGH.

Results: The study included 223 patients. Women were 148 (66.4%) and the mean age was 24.4 ± 8.9 years. PGH was present in 42 patients (18.8%). The head and neck, feet, and lower extremity were the most common sites with PGH. Multivariate logistic regression analysis showed that MKTP performed on the feet significantly increased the odds of PGH (OR 5.856, 95% CI: 2.242-15.292, p value < .001).

Conclusion: PGH is a relatively frequent complication after MKTP, especially when performed on the feet. The follow-up duration might not have been long enough to show some positive effects of the various post-MKTP interventions. Longer follow-up studies are warranted to evaluate preventive strategies.

Objective: To compare a novel microscopic suturing technique with conventional laser therapy for facial nevi ≤2 mm.

Methods: A retrospective study of 60 patients with facial nevi ≤2 mm: 30 underwent novel microscopic suturing (observation) and 30 CO2 laser ablation (control). Outcomes: treatment time, intraoperative bleeding, 6-month VSS, satisfaction, and recurrence.

Results: Observation group showed better scar scores, satisfaction, and lower recurrence; minimal bleeding versus none in control.

Conclusion: Despite longer operative time, novel suturing is superior for long-term scarring, satisfaction, and recurrence; worthy of clinical use.

Background: There is an increasing demand for laser and light-based procedures over larger body surface areas, increasing the risk of encountering nontarget skin areas such as melanocytic nevi and tattoos. Few products exist to block light energy transmission to these skin areas during such procedures.

Objective: To evaluate the effects of four commonly used lasers and intense pulsed light (IPL) on skin shields and other materials aimed for protecting patients.

Materials and methods: The authors performed tests with a 532-nm KTP laser, 810-nm diode laser, 1,064-nm Nd:YAG laser, 2,940-nm Er:YAG laser, and IPL. Their effects were evaluated on adhesive skin shields, laser treatment patches, silk and paper white tape, and laser and IPL eye shields using a laser power and energy meter.

Results: The skin shields demonstrated the lowest or second lowest energy transmission rates when exposed to the 532-nm KTP laser (3.70%), 810-nm laser (7.18%), 2,940-nm Er:YAG laser (0.04%), and IPL (0.99%-1.49%). Damage was seen on both eye and skin shields when exposed to the 1,064-nm Nd:YAG laser.

Conclusion: Skin shields were effective in blocking electromagnetic radiation with all tested lasers and IPL, except the 1,064-nm Nd:YAG laser, thus offering a safe, viable option to protect nontarget skin areas.

Background: After trauma or a variety of nail surgical procedures, there is potential for nail unit epithelium to directly contact dermal connective tissue, putting the nail unit at risk for a bridging scar and resulting dorsal pterygium. To prevent a dorsal pterygium, a variety of materials, including the native nail, have been proposed to splint the proximal nail fold (PNF) and nail matrix (NM).

Objective: To review the indications, materials, and techniques for intraoperative nail splinting during nail unit surgery.

Materials and methods: A comprehensive review of nail splints was conducted in PubMed and OVID Medline.

Results: There are a variety of materials that can be utilized to splint the PNF and NM with various securing techniques. Ideally, this is done with the native nail plate; however, if the native nail plate is unavailable, one can utilize a synthetic nail splint.

Conclusion: If there is trauma or surgery to the nail unit that results in dermal-dermal or dermal-epithelial apposition, it is recommended to splint the sulcus of the PNF from the underlying NM and/or bed during the first 2 to 3 weeks postoperatively. Splinting helps prevent scarring of these opposing tissues and a resulting dorsal pterygium.