Dermatologic Surgery最新文献

Background: Onychocryptosis significantly impacts quality of life. Chemical partial matricectomy with phenol is a common surgical treatment. The use of alcohol as a solvent during this procedure has been controversial. In vitro studies suggest that physiologic saline solution (PSS) may be a more effective solvent for phenol.

Objective: To evaluate the in vivo efficacy of PSS as a phenol solvent, in terms of postoperative outcomes, compared to alcohol.

Methods: A retrospective unicentric cohort study was conducted on patients who underwent partial chemical matricectomy with phenol for onychocryptosis. Sociodemographic and clinical variables were collected and compared between the alcohol and PSS groups. Clinical staging followed Martinez Nova and colleagues' classification. Patients were followed up over a 12-month period to assess postoperative complications.

Results: The study population demonstrated typical characteristics of onychocryptosis, with a median age of 20 years. No statistically significant differences were found between the groups in terms of pain, infections, or bleeding postoperatively. There were also no differences in terms of recurrence, days of analgesic use, or need for antibiotic therapy (p > .05).

Conclusion: The results suggest that PSS is as effective and safe as alcohol as a solvent for phenol in chemical partial matricectomy.

Background: Nonsurgical rhinoplasty (NSR) with dermal fillers has gained popularity because of its immediate and visible results, minimal downtime, and long-lasting effects. However, complications such as filler migration can lead to the development of the "Avatar nose," a condition where the nose appears unnaturally wide and bulbous in the nasion area, disrupting facial harmony. This phenomenon is often exacerbated by the presence of a taut nasofrontal ligament, which tethers the periosteum to the dermal layer and influences nasal contour.

Objective: This study aims to introduce and define the nasofrontal ligament, a previously unrecognized anatomical structure identified during cadaveric dissection, and to measure the penetration force required to traverse this ligament in the context of NSR. By exploring these aspects, the study seeks to enhance the understanding of nasal anatomy and improve the precision and outcomes of filler-based NSR.

Methods: The study involved the dissection of 2 fresh-frozen human cadaveric specimens, during which the nasofrontal ligament was identified. Penetration force was measured using a motorized force tester, with a standardized cannula depth of 5 mm. The force required to traverse the nasofrontal ligament was compared with a control point devoid of ligaments and muscles.

Results: The nasofrontal ligament required a significantly higher penetration force compared with the control point, highlighting its structural integrity and potential impact on filler migration. These findings suggest that subcision of the ligament could prevent the development of the "Avatar nose" and improve the outcomes of NSR.

Conclusion: This study introduces the nasofrontal ligament as a key anatomical structure in NSR and demonstrates its influence on filler migration. Subcision of this ligament may enhance filler stability and aesthetic outcomes. However, the study's limitations, including a small sample size and the exclusive use of Korean cadavers, suggest the need for further research across diverse populations to validate these findings and refine NSR techniques.

Background: The effectiveness and safety of 730-nm picosecond laser for treating acquired bilateral nevus of Ota-like macules remain uncertain.

Objective: This study aims to evaluate the potential benefits and risks of using the 730-nm picosecond laser for ABNOM removal.

Methods: This is a retrospective review of patients who were presented to the clinic between January 2020 and January 2024 for the treatment of ABNOM with 730-nm picosecond laser alone. The efficacy of the laser was assessed based on the Quartile Improvement Scale, using high-resolution photographs evaluated by blinded dermatologists.

Results: A total of 72 Chinese participants with Fitzpatrick skin types III to IV were included in the study. The overall effective rate of the treatment was 75%, achieved after an average of 2.42 ± 0.75 sessions. A subgroup analysis of 41 patients who completed 3 treatment sessions showed statistically significant differences in outcomes across the sessions. The mean improvement scores for sessions 1, 2, and 3 were 1.63 ± 1.04, 2.66 ± 1.22, and 3.29 ± 1.17, respectively (p < .01). No cases of hypopigmentation were observed. The incidence of postinflammatory hyperpigmentation was 5.56%.

Conclusion: The 730-nm picosecond laser is a safe and effective treatment for ABNOM in Chinese patients.

Background: Prognostication of atypical spindle cell neoplasms, including atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS), is challenging; outcomes vary widely, and further identification of prognostic features is crucial.

Objective: To evaluate prognostic factors that may portend worse outcomes in patients with AFX and PDS.

Materials and methods: A retrospective chart review of patients with AFX and PDS was conducted. Data were analyzed using Pearson chi square and T-test. Survival was analyzed using the Kaplan-Meier estimate. A stepwise cox proportional hazards model was created to identify variables associated with increased risk of poor outcomes.

Results: Thirty-four patients with AFX and 10 patients with PDS were identified. PDS had a 60% overall mortality rate (vs 26.5% in AFX), a larger preoperative size of 8.9 cm2 (vs 2.4 cm2) (p < .0001), and a 50% recurrence rate (vs 5.9%) (p = .0039). Female gender (HR 22.18 95% CI 2.54-194.13; p = .001), immunosuppression (HR 5.02 95% CI 1.32-19.12; p = .0044), and perineural invasion (PNI) (HR 78.46 3.97-1,549.56; p = .0091) were associated with increased risk of poor outcomes.

Conclusion: Few large studies have examined clinical features that portend worse outcomes. The authors identify female gender, immunosuppression, and PNI as variables associated with increased risk of recurrence or death.

Background: Policy changes to Mohs micrographic surgery board certification eligibility and population shifts in the wake of the COVID-19 pandemic have significant implications for the accessibility of Mohs micrographic surgeons across the United States.

Objective: To examine the geographic distribution of micrographic surgery providers considering recent population trends and assess the impact of certification eligibility changes and population shifts on accessibility.

Methods and materials: Medicare claims data were utilized to identify micrographic surgery providers. Surgeon densities were calculated per 100,000 people by county and state. Population changes were analyzed using US census data.

Results: Practicing micrographic surgeons were concentrated in metropolitan and nonmetropolitan areas. Overall, 80.4% of counties lacked micrographic surgery providers, with rural areas being the most underserved. Population changes varied among states.

Conclusion: Shifts in micrographic surgery certification requirements, US population distribution, and micrographic surgeon location emphasize challenges in accessibility, especially in rural areas across the United States.