The Journal of dermatologic surgery and oncology最新文献

The author describes a modified mucous-membrane advancement flap for the repair of defects following the removal of premalignant actinic cheilitis or squamous cell carcinoma. The advantages of this modification over other techniques include a more broadly resurfaced lip bilaterally, and prevention of punctate scarring at the lateral oral commissures by use of a continuous mucous membrane in and around the commissures themselves.

Local anesthetics are perhaps the most important drugs used in dermatologic surgery. They allow a variety of procedures to be performed safely and comfortably. Although generally well-tolerated, patients frequently report adverse reactions to these agents and may be labeled as "caine sensitive". In this review we will discuss the approach to the patient with possible local anesthetic sensitivity and in particular will focus on the role of skin testing and challenge in evaluating these patients.

The persistence of facial telangiectasis and erythema in patients with rosacea frequently presents a major cosmetic problem. It may also contribute to relapses of papular and pustular lesions. This study of 27 patients treated for their telangiectasia and erythema with a flash lamp pumped dye laser tuned at 585 nm is described. The laser gave good or excellent reduction of telangiectasia and erythema and overall appearance in 24 of the patients with between one and three treatments. In addition, papule and pustule activity was decreased in 59.2% of the patients, with those with the most severe pre-treatment activity having the most significant improvement. It is suggested that this is a useful additional form of treatment that may improve the telangiectasia and erythematous component of rosacea.

A simple, straight forward, almost mechanical method of drawing the hairline is presented. It is amazing to see how this method, when followed closely, consistently produces a natural, aesthetically pleasing result on all sizes and shapes of heads. It is recognized by the authors that there are a lot of individual variations among hair transplant surgeons and most will be very attractive and quite natural. However, we believe that the following description will provide a good starting point in designing hairlines, and if the basic points are followed, unnatural hairlines will be avoided.

The closure of surgical wounds can be improved by applying some basic techniques for suturing and for correcting suture errors. These techniques include 1) the locking stitch, 2) the pulley stitch for closing large gaping defects, and 3) a means of welding polyfilament synthetic polyamide suture and polypropylene suture.

A new method for the injection of anesthetics is discussed for the tumescent technique of local anesthesia for liposuction. A 12-gauge 30-cm needle with numerous injection ports is used with an injection gun. The technique requires minimal effort and has been found to be a more rapid method of injecting large volumes of fluid than previous systems.

Mohs micrographic surgery for skin cancer (fresh-tissue technique) involves the processing of tissue in a complex fashion. The advantages of this method relate to the asymmetric three-dimensional growth of basal cell carcinoma (BCC). A device is described here based on published knowledge about the growth of BCC. The model demonstrates the precise way in which Mohs surgery varies from other surgical approaches to yield higher cure rates in specific circumstances. This device may be helpful in educating residents and medical students about Mohs surgery and in preparing patients for this procedure.

Anesthesia for cutaneous surgery on the foot is often achieved by local infiltration. However, procedures that involve large surface areas are anesthetized more effectively with peripheral nerve blocks. This discussion of peripheral nerve blocks for the feet includes an overview of the relevant sensory innervation, a brief discussion of local anesthetics, a description of the techniques, and representative cases.