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Undermining is thought to improve wound outcomes; however, randomized controlled data regarding its efficacy are lacking in humans. The objective of this randomized clinical trial was to determine whether undermining low to moderate tension wounds improves scar cosmesis compared to wound closure without undermining. Fifty-four patients, 18 years or older, undergoing primary linear closure of a cutaneous defect with predicted postoperative closure length of ≥ 3 cm on any anatomic site were screened. Four patients were excluded, 50 patients were enrolled, and 48 patients were seen in follow-up. Wounds were divided in half and one side was randomized to receive either no undermining or 2 cm of undermining. The other side received the unselected intervention. Three months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (POSAS). A total of 50 patients [mean (SD) age, 67.6 (11.5) years; 31 (64.6%) male; 48 (100%) white] were enrolled in the study. The mean (SD) sum of the POSAS observer component scores was 12.0 (6.05) for the undermined side and 11.1 (4.68) for the non-undermined side (P = .60). No statistically significant difference was found in the mean (SD) sum of the patient component for the POSAS score between the undermined side [15.9 (9.07)] and the non-undermined side [13.33 (6.20)] at 3 months. For wounds under low to moderate perceived tension, no statistically significant differences in scar outcome or total complications were noted between undermined wound halves and non-undermined halves.Trail Registry: Clinical trials.gov Identifier NCT02289859. https://clinicaltrials.gov/ct2/show/NCT02289859 .

Undermining is thought to improve wound outcomes; however, randomized controlled data regarding its efficacy are lacking in humans. The objective of this randomized clinical trial was to determine whether undermining low to moderate tension wounds improves scar cosmesis compared to wound closure without undermining. Fifty-four patients, 18 years or older, undergoing primary linear closure of a cutaneous defect with predicted postoperative closure length of ≥ 3 cm on any anatomic site were screened. Four patients were excluded, 50 patients were enrolled, and 48 patients were seen in follow-up. Wounds were divided in half and one side was randomized to receive either no undermining or 2 cm of undermining. The other side received the unselected intervention. Three months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (POSAS). A total of 50 patients [mean (SD) age, 67.6 (11.5) years; 31 (64.6%) male; 48 (100%) white] were enrolled in the study. The mean (SD) sum of the POSAS observer component scores was 12.0 (6.05) for the undermined side and 11.1 (4.68) for the non-undermined side (P = .60). No statistically significant difference was found in the mean (SD) sum of the patient component for the POSAS score between the undermined side [15.9 (9.07)] and the non-undermined side [13.33 (6.20)] at 3 months. For wounds under low to moderate perceived tension, no statistically significant differences in scar outcome or total complications were noted between undermined wound halves and non-undermined halves.Trail Registry: Clinical trials.gov Identifier NCT02289859. https://clinicaltrials.gov/ct2/show/NCT02289859 .

Mixed opinions exist regarding cosmetic outcomes of 5-0 fast absorbing plain (FG) gut relative to nonabsorbable suture material, such as 5-0 polypropylene (PP). High quality randomized trials comparing these two suture materials are lacking. To determine whether the use of PP during layered repair of linear cutaneous surgery wounds improves scar cosmesis compared to wound closure with FG. A randomized, split wound, comparative effectiveness trial was undertaken. Patients were evaluated 3 months after the intervention by two blinded physicians using the validated patient observer scar assessment scale (POSAS). Patient assessments were also captured using the same instrument as well as scar width and complications. The mean sum of the six components of the POSAS was 10.26 vs 12.74 for PP and FG, respectively, significantly (p < 0.001) in favor of PP. Mean observer overall opinion similarly showed better outcomes for PP than for FG [1.88 vs 2.52, respectively (p < 0.006)]. The mean sum of the patient assessed components of the POSAS for PP and FG was 12.3 vs 14.34, respectively (p = 0.11). Patient overall opinion significantly favored PP (2.41 vs 3.14, p = 0.043). PP resulted in small but statistically significant better cosmetic outcomes than FG. Pain experienced during suture removal was minimal for most patients.

In order to update recommendations on treatment, supportive care, education and follow-up of patients with invasive cutaneous squamous cell carcinoma (cSCC), a multidisciplinary panel of experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer was formed. Recommendations were based on evidence-based literature review, guidelines and expert consensus. Treatment recommendations are presented for common primary cSCC (low risk, high risk), locally advanced cSCC, regional metastatic cSCC (operable or inoperable) and distant metastatic cSCC. For common primary cSCC (the most frequent cSCC type), first-line treatment is surgical excision with postoperative margin assessment or microscopically controlled sugery. Safety margins containing clinical normal-appearing tissue around the tumour during surgical excision and negative margins as reported in the pathology report are necessary to minimise the risk of local recurrence and metastasis. In case of positive margins, a re-excision shall be done, for operable cases. Lymph node dissection is recommended for cSCC with cytologically or histologically confirmed regional nodal involvement. Radiotherapy should be considered as curative treatment for inoperable cSCC, or for non-surgical candidates. Anti-PD-1 antibodies are the first-line systemic treatment for patients with metastatic or locally advanced cSCC who are not candidates for curative surgery or radiation, with cemiplimab being the first approved systemic agent for advanced cSCC by the Food and Drug Administration/European Medicines Agency. Second-line systemic treatments for advanced cSCC include epidermal growth factor receptor inhibitors (cetuximab) combined with chemotherapy or radiation therapy. Multidisciplinary board decisions are mandatory for all patients with advanced disease who require more than surgery. Patients should be engaged with informed decisions on manage

The purpose of this study was to compare the healing, strength, and cosmetic outcome of linear incisions after repair with the naked eye, surgical loupes, or a surgical microscope. Two parallel incisions were made on the dorsal skin of Sprague-Dawley rats (n = 36) and the rats randomized into four groups. A single surgeon repaired the incisions using 5-0 poliglecaprone in a running subcuticular pattern using the naked eye (Group I), surgical loupes with 2.5× magnification (Group II), surgical microscope with 5-10× magnification (Group III), and 6-0 poliglecaprone with a surgical microscope (Group IV). Rats were sacrificed at 1, 3, and 6 weeks. At each time point, the tensile strength of each closure was assessed. Macroscopic outcomes were evaluated using the Vancouver Scar Scale (VSS) and histology assessed by a blinded observer. Microscope closure took significantly longer than closure with the naked eye (p < 0.05). There was no significant difference in tensile strength or VSS ratings between the closure methods at any of the time points. On histopathologic analysis, there were a greater number of inflammatory cells and fibroblasts in the 6-0 microscope closure group versus the naked eye closure group at week 3 (p ≤ 0.05). In conclusion, wound repair under magnification did not yield a significant difference in cosmesis or wound tensile strength, but did increase operative time. Moreover, there was a trend toward increased inflammation with microscope-assisted closures, perhaps due to the increased suture burden.

The purpose of this study was to compare the healing, strength, and cosmetic outcome of linear incisions after repair with the naked eye, surgical loupes, or a surgical microscope. Two parallel incisions were made on the dorsal skin of Sprague-Dawley rats (n = 36) and the rats randomized into four groups. A single surgeon repaired the incisions using 5-0 poliglecaprone in a running subcuticular pattern using the naked eye (Group I), surgical loupes with 2.5× magnification (Group II), surgical microscope with 5-10× magnification (Group III), and 6-0 poliglecaprone with a surgical microscope (Group IV). Rats were sacrificed at 1, 3, and 6 weeks. At each time point, the tensile strength of each closure was assessed. Macroscopic outcomes were evaluated using the Vancouver Scar Scale (VSS) and histology assessed by a blinded observer. Microscope closure took significantly longer than closure with the naked eye (p < 0.05). There was no significant difference in tensile strength or VSS ratings between the closure methods at any of the time points. On histopathologic analysis, there were a greater number of inflammatory cells and fibroblasts in the 6-0 microscope closure group versus the naked eye closure group at week 3 (p ≤ 0.05). In conclusion, wound repair under magnification did not yield a significant difference in cosmesis or wound tensile strength, but did increase operative time. Moreover, there was a trend toward increased inflammation with microscope-assisted closures, perhaps due to the increased suture burden.

The 2nd Annual Symposium on Hidradenitis Suppurativa Advances (SHSA) took place on 03-05 November 2017 in Detroit, Michigan, USA. This symposium was a joint meeting of the Hidradenitis Suppurativa Foundation (HSF Inc.) founded in the USA, and the Canadian Hidradenitis Suppurativa Foundation (CHSF). This was the second annual meeting of the SHSA with experts from different disciplines arriving from North America, Europe and Australia, in a joint aim to discuss most recent innovations, practical challenges and potential solutions to issues related in the management and care of Hidradenitis Suppurativa patients. The last session involved clinicians, patients and their families in an effort to educate them more about the disease.

Hidradenitis suppurativa is a chronic inflammatory disorder affecting hair follicles, with profoundly negative impact on patient quality of life. Evidence informing ideal evaluation and management of patients with hidradenitis suppurativa is still sparse in many areas, but it has grown substantially in the last decade. Part I of this evidence-based guideline is presented to support health care practitioners as they select optimal management strategies, including diagnostic testing, comorbidity screening, and both complementary and procedural treatment options. Recommendations and evidence grading based on the evidence available at the time of the review are provided.

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of human cancer and has an increasing annual incidence. Although most cSCC is cured with office-based therapy, advanced cSCC poses a significant risk for morbidity, impact on quality of life, and death. This document provides evidence-based recommendations for the management of patients with cSCC. Topics addressed include biopsy techniques and histopathologic assessment, tumor staging, surgical and nonsurgical management, follow-up and prevention of recurrence, and management of advanced disease. The primary focus of these recommendations is on evaluation and management of primary cSCC and localized disease, but where relevant, applicability to recurrent cSCC is noted, as is general information on the management of patients with metastatic disease.

Basal cell carcinoma (BCC) is the most common form of human cancer, with a continually increasing annual incidence in the United States. When diagnosed early, the majority of BCCs are readily treated with office-based therapy, which is highly curative. In these evidence-based guidelines of care, we provide recommendations for the management of patients with BCC, as well as an in-depth review of the best available literature in support of these recommendations. We discuss biopsy techniques for a clinically suspicious lesion and offer recommendations for the histopathologic interpretation of BCC. In the absence of a formal staging system, the best available stratification based on risk for recurrence is reviewed. With regard to treatment, we provide recommendations on treatment modalities along a broad therapeutic spectrum, ranging from topical agents and superficially destructive modalities to surgical techniques and systemic therapy. Finally, we review the available literature and provide recommendations on prevention and the most appropriate follow-up for patients in whom BCC has been diagnosed.

Basal cell carcinoma (BCC) is the most common form of human cancer, with a continually increasing annual incidence in the United States. When diagnosed early, the majority of BCCs are readily treated with office-based therapy, which is highly curative. In these evidence-based guidelines of care, we provide recommendations for the management of patients with BCC, as well as an in-depth review of the best available literature in support of these recommendations. We discuss biopsy techniques for a clinically suspicious lesion and offer recommendations for the histopathologic interpretation of BCC. In the absence of a formal staging system, the best available stratification based on risk for recurrence is reviewed. With regard to treatment, we provide recommendations on treatment modalities along a broad therapeutic spectrum, ranging from topical agents and superficially destructive modalities to surgical techniques and systemic therapy. Finally, we review the available literature and provide recommendations on prevention and the most appropriate follow-up for patients in whom BCC has been diagnosed.

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of human cancer and has an increasing annual incidence. Although most cSCC is cured with office-based therapy, advanced cSCC poses a significant risk for morbidity, impact on quality of life, and death. This document provides evidence-based recommendations for the management of patients with cSCC. Topics addressed include biopsy techniques and histopathologic assessment, tumor staging, surgical and nonsurgical management, follow-up and prevention of recurrence, and management of advanced disease. The primary focus of these recommendations is on evaluation and management of primary cSCC and localized disease, but where relevant, applicability to recurrent cSCC is noted, as is general information on the management of patients with metastatic disease.

ImportanceThe notion that systemic isotretinoin taken within 6 to 12 months of cutaneous surgery contributes to abnormal scarring or delayed wound healing is widely taught and practiced; however, it is based on 3 small case series from the mid-1980s.ObjectiveTo evaluate the body of literature to provide evidence-based recommendations regarding the safety of procedural interventions performed either concurrently with, or immediately following the cessation of systemic isotretinoin therapy.Evidence reviewA panel of national experts in pediatric dermatology, procedural/cosmetic dermatology, plastic surgery, scars, wound healing, acne, and isotretinoin was convened. A systematic PubMed review of English-language articles published from 1982 to 2017 was performed using the following search terms: isotretinoin, 13-cis-retinoic acid, Accutane, retinoids, acitretin, surgery, surgical, laser, ablative laser, nonablative laser, laser hair removal, chemical peel, dermabrasion, wound healing, safety, scarring, hypertrophic scar, and keloid. Evidence was graded, and expert consensus was obtained.FindingsThirty-two relevant publications reported 1485 procedures. There was insufficient evidence to support delaying manual dermabrasion, superficial chemical peels, cutaneous surgery, laser hair removal, and fractional ablative and nonablative laser procedures for patients currently receiving or having recently completed isotretinoin therapy. Based on the available literature, mechanical dermabrasion and fully ablative laser are not recommended in the setting of systemic isotretinoin treatment.Conclusions and relevancePhysicians and patients may have an evidence-based discussion regarding the known risk of cutaneous surgical procedures in the setting of systemic isotretinoin therapy. For some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions.

ImportanceThe notion that systemic isotretinoin taken within 6 to 12 months of cutaneous surgery contributes to abnormal scarring or delayed wound healing is widely taught and practiced; however, it is based on 3 small case series from the mid-1980s.ObjectiveTo evaluate the body of literature to provide evidence-based recommendations regarding the safety of procedural interventions performed either concurrently with, or immediately following the cessation of systemic isotretinoin therapy.Evidence reviewA panel of national experts in pediatric dermatology, procedural/cosmetic dermatology, plastic surgery, scars, wound healing, acne, and isotretinoin was convened. A systematic PubMed review of English-language articles published from 1982 to 2017 was performed using the following search terms: isotretinoin, 13-cis-retinoic acid, Accutane, retinoids, acitretin, surgery, surgical, laser, ablative laser, nonablative laser, laser hair removal, chemical peel, dermabrasion, wound healing, safety, scarring, hypertrophic scar, and keloid. Evidence was graded, and expert consensus was obtained.FindingsThirty-two relevant publications reported 1485 procedures. There was insufficient evidence to support delaying manual dermabrasion, superficial chemical peels, cutaneous surgery, laser hair removal, and fractional ablative and nonablative laser procedures for patients currently receiving or having recently completed isotretinoin therapy. Based on the available literature, mechanical dermabrasion and fully ablative laser are not recommended in the setting of systemic isotretinoin treatment.Conclusions and relevancePhysicians and patients may have an evidence-based discussion regarding the known risk of cutaneous surgical procedures in the setting of systemic isotretinoin therapy. For some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions.

Увод. Базоцелуларни карцином коже (БЦК) је спорорастући малигни епидермални тумор. овај најчешћи тумор у људи иако врло ниског метастатског потенцијала може бити високо инвазиван и значајно допринети морбидитету, угрозити функцију и естетику регије, па и сам живот. Лечење БЦК има за циљ: уклањање тумора, очување здравог ткива и функције, оптимални козметски резултат. Најчешћи вид лечења БЦК је једноставна хируршка ексцизија. Према важећим препорукама БЦК се ексцидирају са заштитним маргинама од 5-10 mm. Одређени броју студија показују директно или индиректно да је клинички одређена маргина врло слична реалној. Оцена адекватности клиничке процене у односу на хистолошку маргину тумора није довољно испитивана. Стопа комплетне ексцизије БЦК (излечење) се не повећава значајно са повећањем сигурносне маргине Циљ истраживања је установљавање односа повезаности између клиничке процене и микроскопски утврђене латералне маргине БЦК на хистолошком препарату. Методологија. У обради узорка од 45 испитаника узети су циљани анамнестички подаци, спроведен клинички преглед, уобичајена хируршке терапије и класична патохистолошка обрада узорака. У методолошкој обради 60 узорака тумора интраоперативно врхом хируршког скалпела целом циркумференцијом клиничке маргине тумора начињен је зарез до нивоа папиларног дермиса. Пре ексцизије додата је заштитна маргина од 4-5 mm. Класична патохистолошка обрада је спроведена као и преглед препарата светлосним микроскопом различитог увеличања (х 40, х 100, х 200, х400). Мерење дистанце између начињеног зареза, и хистолошке границе тумора вршена је уз помоћ милиметарског окулара. Сви добијени подаци унети су у заједничку базу података. За статистичку обраду података коришћен је програм СПСС 21. Коришћене су методе методе дескриптивне статистике, униваријантне и мултивасријантне анализе. Резултати су приказани табеларно и графички, а комплетан рад је обрађен у текст процесору MS Word. Резултати. У 96,7% ексцидираних БЦК удаљеност зареза од патохистоло, Uvod. Bazocelularni karcinom kože (BCK) je spororastući maligni epidermalni tumor. ovaj najčešći tumor u ljudi iako vrlo niskog metastatskog potencijala može biti visoko invazivan i značajno doprineti morbiditetu, ugroziti funkciju i estetiku regije, pa i sam život. Lečenje BCK ima za cilj: uklanjanje tumora, očuvanje zdravog tkiva i funkcije, optimalni kozmetski rezultat. Najčešći vid lečenja BCK je jednostavna hirurška ekscizija. Prema važećim preporukama BCK se ekscidiraju sa zaštitnim marginama od 5-10 mm. Određeni broju studija pokazuju direktno ili indirektno da je klinički određena margina vrlo slična realnoj. Ocena adekvatnosti kliničke procene u odnosu na histološku marginu tumora nije dovoljno ispitivana. Stopa kompletne ekscizije BCK (izlečenje) se ne povećava značajno sa povećanjem sigurnosne margine Cilj istraživanja je ustanovljavanje odnosa povezanosti između kliničke procene i mikroskopski utvrđene lateralne margine BCK na histološkom preparatu. Metodologija. U obradi uzorka od 45 ispitanika uzeti su ciljani anamnestički podaci, sproveden klinički pregled, uobičajena hirurške terapije i klasična patohistološka obrada uzoraka. U metodološkoj obradi 60 uzoraka tumora intraoperativno vrhom hirurškog skalpela celom cirkumferencijom kliničke margine tumora načinjen je zarez do nivoa papilarnog dermisa. Pre ekscizije dodata je zaštitna margina od 4-5 mm. Klasična patohistološka obrada je sprovedena kao i pregled preparata svetlosnim mikroskopom različitog uveličanja (h 40, h 100, h 200, h400). Merenje distance između načinjenog zareza, i histološke granice tumora vršena je uz pomoć milimetarskog okulara. Svi dobijeni podaci uneti su u zajedničku bazu podataka. Za statističku obradu podataka korišćen je program SPSS 21. Korišćene su metode metode deskriptivne statistike, univarijantne i multivasrijantne analize. Rezultati su prikazani tabelarno i grafički, a kompletan rad je obrađen u tekst procesoru MS Word. Rezultati. U 96,7% ekscidiranih BCK udaljenost z, Introduction. Basal cell carcinoma of the skin (BCC) is a slow-growing malignant tumor of epidermis. This most frequent tumour in humans, with a low metastatical potential, can be highly invasive and add significantly to the morbidity rate; it can jeopardize the function and aesthetics of the region as well as one's life itself. Treatment of BCC aims to remove the tumor, preserve healthy tissue and function, and obtain optimal cosmetic result. Simple surgical excision is the most frequent therapeutic option. Current recommendations for surgical excision margins range from 5 to 10mm. A certain number of studies shows either directly or indirectly that the clinical margin is approximately similar to the hystology margin. Estimation of the clinical assesment in relation to the histological margine of tumor has not been sufficiently examined. Incresing the safety margins does not significantly increase the rate of completely excised BCC. Aim. The aim of the research is to establish the relationship between the clinical assessment and microscopically determined lateral margins of BCC in histopathological sample. Methods. In 45 patients, selected data from anamnesis have been taken, clinical examination has been conducted, as well as a regular surgical treatment, and a classical histopathological evaluation of samples. In 60 samples of the tumours intraoperatively, an circumferential incision at the clinical margin with the tip of surgical knife to the level of papillary dermis is made. Prior to the excision an additional safety margin is added. A standard histopathological processing, microscopic examination with various magnification range (40x, 100x, 200x, 400x) and the measurement of the distance between the incision and the histological margin of tumor was done with the milimetar graded ocular. All the data have entries in the common database. Statistical data processing was conducted by the statistical package SPSS 21. The following methods were used: descriptive st

BackgroundFew studies illustrate the contributions made by various specialties in pioneering commonly performed noninvasive and minimally invasive cosmetic and surgical procedures.ObjectiveTo evaluate the contributions made by various specialties in pioneering noninvasive and minimally invasive cosmetic and surgical procedures.Materials and methodsKey words using the Medical Search Headings Database were used to query in the Thomson Reuters Web of Science Database. The 25 most highly cited studies were sorted according to the citation number. The author specialty was identified and assigned scores based on the number of citations.ResultsDermatology was identified as the specialty with the greatest contribution to botulinum toxin treatments for rhytides, injectable fillers, laser treatments, chemical peels, and noninvasive body contouring. Neurology was identified as the leading specialty in botulinum toxin treatments for hyperhidrosis, and vascular surgery was identified as leading specialty in sclerotherapy. Plastic surgery was identified as having made the greatest contribution to hair transplantation, and liposuction.ConclusionDermatology was identified as the leading specialty for the majority of noninvasive and minimally invasive cosmetic procedures. Other specialties have also contributed important literature to this area.

BackgroundFew studies illustrate the contributions made by various specialties in pioneering commonly performed noninvasive and minimally invasive cosmetic and surgical procedures.ObjectiveTo evaluate the contributions made by various specialties in pioneering noninvasive and minimally invasive cosmetic and surgical procedures.Materials and methodsKey words using the Medical Search Headings Database were used to query in the Thomson Reuters Web of Science Database. The 25 most highly cited studies were sorted according to the citation number. The author specialty was identified and assigned scores based on the number of citations.ResultsDermatology was identified as the specialty with the greatest contribution to botulinum toxin treatments for rhytides, injectable fillers, laser treatments, chemical peels, and noninvasive body contouring. Neurology was identified as the leading specialty in botulinum toxin treatments for hyperhidrosis, and vascular surgery was identified as leading specialty in sclerotherapy. Plastic surgery was identified as having made the greatest contribution to hair transplantation, and liposuction.ConclusionDermatology was identified as the leading specialty for the majority of noninvasive and minimally invasive cosmetic procedures. Other specialties have also contributed important literature to this area.

ImportanceAlthough applying adhesive strips to a wound closure has been shown to have outcomes equivalent to those with cuticular suturing, it is unknown whether adhesive strips provide additional benefit compared with dermal suturing alone.ObjectiveTo determine whether the addition of adhesive strips to a wound closed with buried interrupted subcuticular sutures improves outcomes following wound closure.Design, setting, and participantsA prospective, randomized split-wound intervention was conducted between November 14, 2013, and May 16, 2014, in patients who underwent cutaneous surgical procedures at the University of California, Davis, outpatient dermatology clinic. Fifty-seven patients 18 years or older with postoperative defects of at least 3 cm, resulting from either Mohs micrographic surgical procedures or surgical excision, were screened for participation. Nine patients were excluded and 48 were enrolled.InterventionsHalf of each wound was randomized to receive buried interrupted subcuticular sutures and overlying adhesive strips and the other half received buried interrupted subcuticular sutures only.Main outcomes and measuresAt 3 months' follow-up, each patient and 2 blinded observers evaluated the wound using the Patient Observer Scar Assessment Scale.ResultsThe total mean (SD) Patient Observer Scar Assessment Scale score for observers for the side that received a combination of adhesive strips and buried interrupted subcuticular suturing (12.3 [4.8]) and the side that received sutures only (12.9 [6.3]) did not differ significantly at 3 months (P = .32). There was no significant difference in the total patient assessment scale score between the combination closure (14.0 [7.6]) and sutures only (14.7 [7.6]) sides at 3 months (P = .39). There was also no significant difference between the 2 closure methods in terms of mean (SD) scar width (both methods: 1.1 [0.8] mm, P = .89) at follow-up.Conclusions and relevanceCombination closure with adhesive strips and

BackgroundWound edge eversion has been hypothesized to improve aesthetic outcomes after cutaneous wound closure. Data supporting this assertion are sparse.ObjectiveWe sought to determine if wound eversion, achieved with interrupted subcuticular sutures, improves aesthetic outcome compared with planar closures.MethodsWe undertook a prospective, randomized, split-scar intervention in patients who underwent cutaneous surgery. Half of the wound was randomized to an everted or planar repair; the other side received the opposite one. At 3- and 6-month follow-up, both the patient and 2 blinded observers evaluated the wound using the Patient Observer Self-Assessment Scale (POSAS).ResultsThe total observer POSAS score for the everted (13.59, 12.26) and planar (12.91, 12.98) sides did not differ significantly at 3 or 6 months, respectively. Similarly, there was not a significant difference in patient assessment between the everted (16.23, 12.84) and planar (15.07, 12.79) sides at 3 or 6 months, respectively. Finally, there was no significant difference between the 2 closure methods in terms of scar height or width at follow-up.LimitationsThis was a single-center trial, which used a validated but still subjective scar assessment instrument.ConclusionWound eversion was not significantly associated with improved overall scar assessments by blinded observers or patient assessment.

ImportanceAlthough applying adhesive strips to a wound closure has been shown to have outcomes equivalent to those with cuticular suturing, it is unknown whether adhesive strips provide additional benefit compared with dermal suturing alone.ObjectiveTo determine whether the addition of adhesive strips to a wound closed with buried interrupted subcuticular sutures improves outcomes following wound closure.Design, setting, and participantsA prospective, randomized split-wound intervention was conducted between November 14, 2013, and May 16, 2014, in patients who underwent cutaneous surgical procedures at the University of California, Davis, outpatient dermatology clinic. Fifty-seven patients 18 years or older with postoperative defects of at least 3 cm, resulting from either Mohs micrographic surgical procedures or surgical excision, were screened for participation. Nine patients were excluded and 48 were enrolled.InterventionsHalf of each wound was randomized to receive buried interrupted subcuticular sutures and overlying adhesive strips and the other half received buried interrupted subcuticular sutures only.Main outcomes and measuresAt 3 months' follow-up, each patient and 2 blinded observers evaluated the wound using the Patient Observer Scar Assessment Scale.ResultsThe total mean (SD) Patient Observer Scar Assessment Scale score for observers for the side that received a combination of adhesive strips and buried interrupted subcuticular suturing (12.3 [4.8]) and the side that received sutures only (12.9 [6.3]) did not differ significantly at 3 months (P = .32). There was no significant difference in the total patient assessment scale score between the combination closure (14.0 [7.6]) and sutures only (14.7 [7.6]) sides at 3 months (P = .39). There was also no significant difference between the 2 closure methods in terms of mean (SD) scar width (both methods: 1.1 [0.8] mm, P = .89) at follow-up.Conclusions and relevanceCombination closure with adhesive strips and

BackgroundWound edge eversion has been hypothesized to improve aesthetic outcomes after cutaneous wound closure. Data supporting this assertion are sparse.ObjectiveWe sought to determine if wound eversion, achieved with interrupted subcuticular sutures, improves aesthetic outcome compared with planar closures.MethodsWe undertook a prospective, randomized, split-scar intervention in patients who underwent cutaneous surgery. Half of the wound was randomized to an everted or planar repair; the other side received the opposite one. At 3- and 6-month follow-up, both the patient and 2 blinded observers evaluated the wound using the Patient Observer Self-Assessment Scale (POSAS).ResultsThe total observer POSAS score for the everted (13.59, 12.26) and planar (12.91, 12.98) sides did not differ significantly at 3 or 6 months, respectively. Similarly, there was not a significant difference in patient assessment between the everted (16.23, 12.84) and planar (15.07, 12.79) sides at 3 or 6 months, respectively. Finally, there was no significant difference between the 2 closure methods in terms of scar height or width at follow-up.LimitationsThis was a single-center trial, which used a validated but still subjective scar assessment instrument.ConclusionWound eversion was not significantly associated with improved overall scar assessments by blinded observers or patient assessment.

BackgroundThe public preference for provider type in performing cutaneous surgery and cosmetic procedures is unknown in the United States.MethodsAn internet-based survey was administered to the lay public. Respondents were asked to select the health care provider (dermatologist, plastic surgeon, primary care physician, general surgeon, and nurse practitioner/physician's assistant) they mostly prefer to perform different cutaneous cosmetic and surgical procedures.ResultsThree hundred fifty-four respondents undertook the survey. Dermatologists were identified as the most preferable health care provider to evaluate and biopsy worrisome lesions on the face (69.8%), perform skin cancer surgery on the back (73.4%), perform skin cancer surgery on the face (62.7%), and perform laser procedures (56.3%) by most of the respondents. For filler injections, the responders similarly identified plastic surgeons and dermatologists (47.3% vs 44.6%, respectively) as the most preferred health care provider. For botulinum toxin injections, there was a slight preference for plastic surgeons followed by dermatologists (50.6% vs 38.4%). Plastic surgeons were the preferred health care provider for procedures such as liposuction (74.4%) and face-lift surgery (96.1%) by most of the respondents.ConclusionDermatologists are recognized as the preferred health care providers over plastic surgeons, primary care physicians, general surgeons, and nurse practitioners/physician's assistants to perform a variety of cutaneous cosmetic and surgical procedures including skin cancer surgery, on the face and body, and laser procedures. The general public expressed similar preferences for dermatologists and plastic surgeons regarding filler injections.

ImportanceExcisional skin cancer surgery is a common procedure, with no formal consensus for mitigating the risk of wrong-site cutaneous surgery.ObjectiveTo systematically consider the usefulness and feasibility of proposed methods for correct biopsy site identification in dermatology.Evidence reviewSurvey study with a formal consensus process. Item development was via a literature review and expert interviews, followed by 2 stages of a Delphi process to develop consensus recommendations.FindingsIn total, 2323 articles were reviewed in the literature search, with data extraction from 14. Twenty-five experts underwent 30-minute structured interviews, which were transcribed and coded. The resulting survey was composed of 42 proposed interventions by multiple stakeholders (biopsying physicians, operating physicians, nurses, ancillary staff, patients, caregivers, and family members) at 3 time points (day of biopsy, delay and consultation period, and day of definitive surgery). Two rounds of a Delphi process with 59 experts (25 academic and 34 private practice) scored the survey. Strong consensus was obtained on 14 behaviors, and moderate consensus was obtained on 21 other behaviors. In addition, a 2-state simultaneous algorithm was developed to model surgeon behavior on the day of definitive surgery based on surgeon and patient perceptions.Conclusions and relevanceWhen definitive surgery is performed after the initial biopsy and by a different surgeon, procedures can be implemented at several time points to increase the likelihood of correct site identification. The specific circumstances of a case suggest which methods may be most appropriate and feasible, and some may be implemented. The risk of wrong-site cutaneous surgery can be reduced but not eliminated.

Background: The set-back suture, an absorbable dermal suturing technique, purportedly improves wound eversion and cosmetic outcomes. Objective: We sought to conduct a split-wound, prospective, randomized study to compare the cosmetic outcome and wound eversion achieved with the set-back suture and the buried vertical mattress suture (BVMS). Methods: A total of 46 surgical elliptical wounds were randomized to subcuticular closure with the set-back suture on half and the BVMS on the other. Maximum eversion height and width were measured immediately postoperatively. At 3 months, 2 blinded observers evaluated each scar using a 7-point Likert physician global scar assessment scale. Subjects and observers also completed the validated Patient and Observer Scar Assessment Scale, where a score of 6 represents normal-appearing skin and 60 represents worst imaginable scar. Results: In all, 42 subjects completed the study. The set-back suture provided statistically significant wound eversion. On the Likert scale, observers rated the set-back suture side 1 point better than the BVMS side. Both patient and observer total Patient and Observer Scar Assessment Scale scores were significantly lower for the set-back suture side (subject mean 13.0 ± 8.7 vs 16.2 ± 12.0 [P = .039]; observer mean 24.5 ± 10.4 vs 27.7 ± 13.6 [P = .028], respectively). Limitations: Single institution experience and relatively short follow-up are limitations. Conclusion: The set-back suture provides superior wound eversion and better cosmetic outcomes than the BVMS. © 2014 American Academy of Dermatology, Inc.

ImportanceExcisional skin cancer surgery is a common procedure, with no formal consensus for mitigating the risk of wrong-site cutaneous surgery.ObjectiveTo systematically consider the usefulness and feasibility of proposed methods for correct biopsy site identification in dermatology.Evidence reviewSurvey study with a formal consensus process. Item development was via a literature review and expert interviews, followed by 2 stages of a Delphi process to develop consensus recommendations.FindingsIn total, 2323 articles were reviewed in the literature search, with data extraction from 14. Twenty-five experts underwent 30-minute structured interviews, which were transcribed and coded. The resulting survey was composed of 42 proposed interventions by multiple stakeholders (biopsying physicians, operating physicians, nurses, ancillary staff, patients, caregivers, and family members) at 3 time points (day of biopsy, delay and consultation period, and day of definitive surgery). Two rounds of a Delphi process with 59 experts (25 academic and 34 private practice) scored the survey. Strong consensus was obtained on 14 behaviors, and moderate consensus was obtained on 21 other behaviors. In addition, a 2-state simultaneous algorithm was developed to model surgeon behavior on the day of definitive surgery based on surgeon and patient perceptions.Conclusions and relevanceWhen definitive surgery is performed after the initial biopsy and by a different surgeon, procedures can be implemented at several time points to increase the likelihood of correct site identification. The specific circumstances of a case suggest which methods may be most appropriate and feasible, and some may be implemented. The risk of wrong-site cutaneous surgery can be reduced but not eliminated.

BackgroundThe public preference for provider type in performing cutaneous surgery and cosmetic procedures is unknown in the United States.MethodsAn internet-based survey was administered to the lay public. Respondents were asked to select the health care provider (dermatologist, plastic surgeon, primary care physician, general surgeon, and nurse practitioner/physician's assistant) they mostly prefer to perform different cutaneous cosmetic and surgical procedures.ResultsThree hundred fifty-four respondents undertook the survey. Dermatologists were identified as the most preferable health care provider to evaluate and biopsy worrisome lesions on the face (69.8%), perform skin cancer surgery on the back (73.4%), perform skin cancer surgery on the face (62.7%), and perform laser procedures (56.3%) by most of the respondents. For filler injections, the responders similarly identified plastic surgeons and dermatologists (47.3% vs 44.6%, respectively) as the most preferred health care provider. For botulinum toxin injections, there was a slight preference for plastic surgeons followed by dermatologists (50.6% vs 38.4%). Plastic surgeons were the preferred health care provider for procedures such as liposuction (74.4%) and face-lift surgery (96.1%) by most of the respondents.ConclusionDermatologists are recognized as the preferred health care providers over plastic surgeons, primary care physicians, general surgeons, and nurse practitioners/physician's assistants to perform a variety of cutaneous cosmetic and surgical procedures including skin cancer surgery, on the face and body, and laser procedures. The general public expressed similar preferences for dermatologists and plastic surgeons regarding filler injections.

BACKGROUND AND OBJECTIVES: Treatment of a variety of skin disorders with ablative fractional lasers (AFXL) is driving the development of portable AFXLs. This study measures micropore dimensions produced by a small 2,940 nm AFXL using a variety of stacked pulses, and determines a model correlating laser parameters with tissue effects.MATERIALS AND METHODS: Ex vivo pig skin was exposed to a miniaturized 2,940 nm AFXL, spot size 225 µm, density 5%, power levels 1.15-2.22 W, pulse durations 50-225 microseconds, pulse repetition rates 100-500 Hz, and 2, 20, or 50 stacked pulses, resulting in pulse energies of 2.3-12.8 mJ/microbeam and total energy levels of 4.6-640 mJ/microchannel. Histological endpoints were ablation depth (AD), coagulation zone (CZ) and ablation width (AW). Data were logarithmically transformed if required prior to linear regression analyses. Results for histological endpoints were combined in a mathematical model.RESULTS: In 138 sections from 91 biopsies, AD ranged from 16 to a maximum of 1,348 µm and increased linearly with the logarithm of total energy delivered by stacked pulses, but also depended on variations in power, pulse duration, pulse repetition rate, and pulse energy (r(2) = 0.54-0.85, P < 0.0001). Microchannels deeper than 500 µm were created only by the highest pulse energy of 12.8 mJ/microbeam. Pulse stacking increased AD, and enlarged CZ and AW. CZ varied from 0 to 205 µm and increased linearly with total energy (r(2) = 0.56-0.75, P < 0.0001). AW ranged from 106 to 422 µm and increased linearly with the logarithm of number of stacked pulses (r(2) = 0.53-0.61, P < 0.001). The mathematical model estimated micropores of specific ADs with an associated range of CZs and AWs, for example, 300 µm ADs were associated with CZs from 27 to 73 µm and AWs from 190 to 347 µm.CONCLUSIONS: Pulse stacking with a small, low power 2,940 nm AFXL created reproducible shallow to deep micropores, and influenced micropore c

info:eu-repo/semantics/published

BACKGROUND AND OBJECTIVES: Treatment of a variety of skin disorders with ablative fractional lasers (AFXL) is driving the development of portable AFXLs. This study measures micropore dimensions produced by a small 2,940 nm AFXL using a variety of stacked pulses, and determines a model correlating laser parameters with tissue effects.MATERIALS AND METHODS: Ex vivo pig skin was exposed to a miniaturized 2,940 nm AFXL, spot size 225 µm, density 5%, power levels 1.15-2.22 W, pulse durations 50-225 microseconds, pulse repetition rates 100-500 Hz, and 2, 20, or 50 stacked pulses, resulting in pulse energies of 2.3-12.8 mJ/microbeam and total energy levels of 4.6-640 mJ/microchannel. Histological endpoints were ablation depth (AD), coagulation zone (CZ) and ablation width (AW). Data were logarithmically transformed if required prior to linear regression analyses. Results for histological endpoints were combined in a mathematical model.RESULTS: In 138 sections from 91 biopsies, AD ranged from 16 to a maximum of 1,348 µm and increased linearly with the logarithm of total energy delivered by stacked pulses, but also depended on variations in power, pulse duration, pulse repetition rate, and pulse energy (r(2) = 0.54-0.85, P < 0.0001). Microchannels deeper than 500 µm were created only by the highest pulse energy of 12.8 mJ/microbeam. Pulse stacking increased AD, and enlarged CZ and AW. CZ varied from 0 to 205 µm and increased linearly with total energy (r(2) = 0.56-0.75, P < 0.0001). AW ranged from 106 to 422 µm and increased linearly with the logarithm of number of stacked pulses (r(2) = 0.53-0.61, P < 0.001). The mathematical model estimated micropores of specific ADs with an associated range of CZs and AWs, for example, 300 µm ADs were associated with CZs from 27 to 73 µm and AWs from 190 to 347 µm.CONCLUSIONS: Pulse stacking with a small, low power 2,940 nm AFXL created reproducible shallow to deep micropores, and influenced micropore c

Recent advances in optical technologies have produced laser systems capable of optimizing the appearance of scars from various etiologies. Laser treatment can commence as early as the time of the initial injury and as late as several years after the injury. Optimal results can now be attained with minimal down time. Herein, we review several available optical technologies for treatment of surgical, traumatic, and inflammatory scars, based upon our clinical experience.

Recent advances in optical technologies have produced laser systems capable of optimizing the appearance of scars from various etiologies. Laser treatment can commence as early as the time of the initial injury and as late as several years after the injury. Optimal results can now be attained with minimal down time. Herein, we review several available optical technologies for treatment of surgical, traumatic, and inflammatory scars, based upon our clinical experience.

The inverted-T skin-reducing mastectomy with implant reconstruction represents a very effective reconstructive and cosmetic option in patients with macromastia. However, in this subset of patients, the risk of skin flap necrosis, especially at the T-junction, is significant. In this setting, complete implant coverage with viable tissue beneath the mastectomy skin flaps is essential to reduce morbidity. In this article, the authors retrospectively review their series of 16 skin-reducing mastectomy and immediate one-stage implant reconstructions using the submuscular-subfascial pocket, analyzing the reconstructive issues and cosmetic outcomes.

Obesity has become a worldwide metabolic disease, necessitating appropriate treatment. Conservative therapy has shown lack of success long term on managing weight loss and comorbidities. On the other hand, bariatric surgery has demonstrated effectiveness. Unfortunately, bariatric patients experience significant skin excess, laxity, and ptosis which may lead to postural, functional, hygienic, dermatologic, and aesthetic impairments. These can be corrected only with body-contouring surgery. Among these procedures, abdominoplasty is one of the most commonly performed operations. In 1977, Planas presented his "vest over pants" abdominoplasty, which had several advantages over the previous approaches. In this study, the technique was tested on post-bariatric patients. From 2005 to 2008, subsequent to laparoscopic biliopancreatic diversion, a tummy tuck was performed on 35 patients (28 females; 7 males). The patients were followed up for a mean period of 5 years. After abdominal contouring, 22 patients had an uneventful recovery and local complications were reported in the other 13 patients. Several advantages of this abdominal lipectomy method were recorded: minimal infection rate and single flap weight; high vascular safety; excellent matching of the flaps' thickness and scar position on the abdomen; minimal cumbersome maneuver and traction of the tissues; relatively short operating and lead time; and discrete comfort for the assistants and surgeon. In conclusion, the "vest over pants" abdominoplasty in post-bariatric patients has been demonstrated to be effective, fast to perform, comfortable for the surgeon, and safe.

The inverted-T skin-reducing mastectomy with implant reconstruction represents a very effective reconstructive and cosmetic option in patients with macromastia. However, in this subset of patients, the risk of skin flap necrosis, especially at the T-junction, is significant. In this setting, complete implant coverage with viable tissue beneath the mastectomy skin flaps is essential to reduce morbidity. In this article, the authors retrospectively review their series of 16 skin-reducing mastectomy and immediate one-stage implant reconstructions using the submuscular-subfascial pocket, analyzing the reconstructive issues and cosmetic outcomes.

Background and objectiveDue to the significant risk profile associated with traditional ablative resurfacing, a safer and less invasive treatment approach known as fractional deep dermal ablation (FDDA) was recently developed. We report the results of the first clinical investigation of this modality for treatment of photodamaged skin.Study design/materials and methodsTwenty-four subjects received treatments on the inner forearm with a prototype fractional CO(2) laser device (Reliant Technologies Inc., Mountain View, CA) at settings of 5-40 mJ/MTZ and 400 MTZ/cm(2). Clinical and histological effects were assessed by study investigators 1 week, 1 month, and 3 months following treatment. Thirty subjects were then enrolled in a multi-center study for treatment of photodamage using the same device. Subjects received 1-2 treatments on the face and neck, with energies ranging from 10 to 40 mJ/MTZ and densities ranging from 400 to 1,200 MTZ/cm(2). Study investigators assessed severity of post-treatment responses during follow-up visits 48 hours, 1 week, 1 month, and 3 months following treatment. Using a standard quartile improvement scale (0-4), subjects and investigators assessed improvement in rhytides, pigmentation, texture, laxity and overall appearance 1 and 3 months post-treatment.ResultsClinical and histologic results demonstrated that fractional delivery of a 10,600 nm CO(2) laser source offers an improved safety profile with respect to traditional ablative resurfacing, while still effectively resurfacing epidermal and dermal tissue. Forearm and facial treatments were well-tolerated with no serious adverse events observed. Eighty-three percent of subjects exhibited moderate or better overall improvement (50-100%), according to study investigator quartile scoring.ConclusionsFDDA treatment is a safe and promising new approach for resurfacing of epidermal and deep dermal tissue targets.

BackgroundAblative fractional carbon dioxide (CO(2)) laser treatments have gained popularity due to their efficacy, shortened downtime, and decreased potential for scarring in comparison to traditional ablative CO(2) resurfacing. To date, scarring with fractional CO(2) lasers has not been reported.ObjectiveFive patients treated with the same fractional CO(2) laser technology for photodamage of the neck were referred to our practices 1-3 months after treatment. Each patient developed scarring. Of the five cases, two are discussed in detail. The first was treated under general anesthesia on the face and anterior neck at a pulse energy of 30 mJ (859 microm depth) with 25% coverage. Eleven days after treatment, three non-healing areas along the horizontal skin folds of the anterior neck were noted. At 2 weeks after CO(2) ablative fractional resurfacing, these areas had become thickened. These raised areas were treated with a non-ablative fractionated 1,550 nm laser to modify the wound healing milieu. One week later, distinct firm pale papules in linear arrays with mild hypopigmentation had developed along involved neck skin folds. Skin biopsy was performed. For the second patient, the neck was treated at a pulse energy of 20 mJ (630 microm depth) with 30% coverage of the exposed skin, with a total treatment energy of 5.0 kJ. Minimal crusting was noted on the neck throughout the initial healing phase of 2 weeks. She then experienced tightness on her neck. Approximately 3 weeks after treatment, she developed multiple vertical and horizontal hypertrophic scars (HS).ResultsHistopathology for the first case confirmed the presence of a hypertrophic scar. The papules in this case completely resolved with mild residual hypopigmentation after treatment with topical corticosteroids. HS failed to resolve in the second case to date after 1 month.ConclusionAs with traditional ablative CO(2) laser resurfacing, HS is a potential complication of ablative fractional CO(2) laser resurfac

BackgroundAblative fractional carbon dioxide (CO(2)) laser treatments have gained popularity due to their efficacy, shortened downtime, and decreased potential for scarring in comparison to traditional ablative CO(2) resurfacing. To date, scarring with fractional CO(2) lasers has not been reported.ObjectiveFive patients treated with the same fractional CO(2) laser technology for photodamage of the neck were referred to our practices 1-3 months after treatment. Each patient developed scarring. Of the five cases, two are discussed in detail. The first was treated under general anesthesia on the face and anterior neck at a pulse energy of 30 mJ (859 microm depth) with 25% coverage. Eleven days after treatment, three non-healing areas along the horizontal skin folds of the anterior neck were noted. At 2 weeks after CO(2) ablative fractional resurfacing, these areas had become thickened. These raised areas were treated with a non-ablative fractionated 1,550 nm laser to modify the wound healing milieu. One week later, distinct firm pale papules in linear arrays with mild hypopigmentation had developed along involved neck skin folds. Skin biopsy was performed. For the second patient, the neck was treated at a pulse energy of 20 mJ (630 microm depth) with 30% coverage of the exposed skin, with a total treatment energy of 5.0 kJ. Minimal crusting was noted on the neck throughout the initial healing phase of 2 weeks. She then experienced tightness on her neck. Approximately 3 weeks after treatment, she developed multiple vertical and horizontal hypertrophic scars (HS).ResultsHistopathology for the first case confirmed the presence of a hypertrophic scar. The papules in this case completely resolved with mild residual hypopigmentation after treatment with topical corticosteroids. HS failed to resolve in the second case to date after 1 month.ConclusionAs with traditional ablative CO(2) laser resurfacing, HS is a potential complication of ablative fractional CO(2) laser resurfac

Background and objectiveDue to the significant risk profile associated with traditional ablative resurfacing, a safer and less invasive treatment approach known as fractional deep dermal ablation (FDDA) was recently developed. We report the results of the first clinical investigation of this modality for treatment of photodamaged skin.Study design/materials and methodsTwenty-four subjects received treatments on the inner forearm with a prototype fractional CO(2) laser device (Reliant Technologies Inc., Mountain View, CA) at settings of 5-40 mJ/MTZ and 400 MTZ/cm(2). Clinical and histological effects were assessed by study investigators 1 week, 1 month, and 3 months following treatment. Thirty subjects were then enrolled in a multi-center study for treatment of photodamage using the same device. Subjects received 1-2 treatments on the face and neck, with energies ranging from 10 to 40 mJ/MTZ and densities ranging from 400 to 1,200 MTZ/cm(2). Study investigators assessed severity of post-treatment responses during follow-up visits 48 hours, 1 week, 1 month, and 3 months following treatment. Using a standard quartile improvement scale (0-4), subjects and investigators assessed improvement in rhytides, pigmentation, texture, laxity and overall appearance 1 and 3 months post-treatment.ResultsClinical and histologic results demonstrated that fractional delivery of a 10,600 nm CO(2) laser source offers an improved safety profile with respect to traditional ablative resurfacing, while still effectively resurfacing epidermal and dermal tissue. Forearm and facial treatments were well-tolerated with no serious adverse events observed. Eighty-three percent of subjects exhibited moderate or better overall improvement (50-100%), according to study investigator quartile scoring.ConclusionsFDDA treatment is a safe and promising new approach for resurfacing of epidermal and deep dermal tissue targets.

The cure without after-effect of an hemangioma is classic but sometimes the spontaneous involution, a premature surgical treatment or an evolutionary complication can be at the origin of a definitive after-effect. In these cases, the treatment of the hemangioma, often multidisciplinary, will be begun in a late way during the late childhood or the adolescence. Surgical excision of an excess tissue or of a wide scar, lipoaspiration of a fat remainder, lasertherapy and fat tissue reinjection are simple and mostly sufficient procedures. In the most complex cases, notably at the facial site, a surgery heavier as a rhinoplasty, a resection of lip, a local flap or orthognatic surgery can be necessary.

BackgroundAlthough cryogen spray cooling (CSC) is used to minimize the risk of epidermal damage during laser dermatologic surgery, concern has been expressed that CSC may induce cryo-injury. In order to address this concern, it is necessary to evaluate the effects of prolonged exposure of human skin phantoms (HSP) to CSC.ObjectiveTo measure the minimum surface temperature (T(min)) and the time at which it occurs (t(Tmin)) as well as determine the time the sprayed HSP surface remains below 0 degrees C (sub-zero time, Deltat(s)) and -26 degrees C (residence time, Deltat(r)) during the application of single (SCS) and multiple (MCS) cryogen spurts. Two initial HSP substrate temperatures were studied, T(i): 23 and 70 degrees C.Study design/materials and methodsAn epoxy-based HSP was constructed to measure T(min), t(Tmin), Deltat(s), and Deltat(r), for 17 spray patterns: 1 SCS with a total cryo-delivery time (Deltat(c)) of 40 milliseconds; 8 MCS patterns with identical Deltat(c), but with a total cooling time (Deltat(total)) varying from 50 to 280 milliseconds; and 8 SCS patterns that matched the Deltat(total) of the MCS patterns.ResultsFor both T(i), our results show that it is possible to distinguish between two different cooling regimes. For Deltat(total) ConclusionsThese results suggest that: (1) similar epidermal protection may be attained with SCS and MCS for Deltat(total)

BackgroundAlthough cryogen spray cooling (CSC) is used to minimize the risk of epidermal damage during laser dermatologic surgery, concern has been expressed that CSC may induce cryo-injury. In order to address this concern, it is necessary to evaluate the effects of prolonged exposure of human skin phantoms (HSP) to CSC.ObjectiveTo measure the minimum surface temperature (T(min)) and the time at which it occurs (t(Tmin)) as well as determine the time the sprayed HSP surface remains below 0 degrees C (sub-zero time, Deltat(s)) and -26 degrees C (residence time, Deltat(r)) during the application of single (SCS) and multiple (MCS) cryogen spurts. Two initial HSP substrate temperatures were studied, T(i): 23 and 70 degrees C.Study design/materials and methodsAn epoxy-based HSP was constructed to measure T(min), t(Tmin), Deltat(s), and Deltat(r), for 17 spray patterns: 1 SCS with a total cryo-delivery time (Deltat(c)) of 40 milliseconds; 8 MCS patterns with identical Deltat(c), but with a total cooling time (Deltat(total)) varying from 50 to 280 milliseconds; and 8 SCS patterns that matched the Deltat(total) of the MCS patterns.ResultsFor both T(i), our results show that it is possible to distinguish between two different cooling regimes. For Deltat(total) ConclusionsThese results suggest that: (1) similar epidermal protection may be attained with SCS and MCS for Deltat(total)

C4.4A, a structural homologue of the urokinase-type plasminogen activator receptor (uPAR), was originally identified as a metastasis-associated membrane protein, but little is known about its structural and functional properties. Therefore, we expressed, purified and characterized a soluble truncated form of human C4.4A, and used this protein to produce specific polyclonal anti-C4.4A antibodies. By immunohistochemistry we observed a pronounced surface staining for C4.4A in suprabasal keratinocytes of chronic human wounds and found C4.4A expression markedly upregulated in migrating keratinocytes during re-epithelisation of incisional skin wounds. Phorbol-ester-induced hyperplasia of mouse skin is also accompanied by a significant induction of C4.4A expression in the multilayered, suprabasal keratinocytes. C4.4A contains two Ly-6 (leucocyte antigen 6)/uPAR/alpha-neurotoxin modules. Our recombinant human C4.4A is extensively modified by post-translational glycosylation, which include 5-6 N-linked carbohydrates primarily located in or close to its second Ly-6/uPAR/alpha-neurotoxin module and approximately 15 O-linked carbohydrates clustered in a Ser/Thr/Pro-rich region at the C-terminus. A highly protease-sensitive region (Tyr200-Arg204) is located between these two clusters of N- and O-linked carbohydrates. The natural, glycolipid-anchored C4.4A from amnion membranes of human term placenta exhibits similar properties. Using recombinant, soluble C4.4A or MCF 7 cells, which express significant amounts of GPI-anchored C4.4A, we find no evidence for an interaction between C4.4A and uPA, a property suggested previously for rat C4.4A. Collectively these data indicate that C4.4A, although being a structural homologue of uPAR, is unlikely to have a functional overlap with uPAR.

C4.4A, a structural homologue of the urokinase-type plasminogen activator receptor (uPAR), was originally identified as a metastasis-associated membrane protein, but little is known about its structural and functional properties. Therefore, we expressed, purified and characterized a soluble truncated form of human C4.4A, and used this protein to produce specific polyclonal anti-C4.4A antibodies. By immunohistochemistry we observed a pronounced surface staining for C4.4A in suprabasal keratinocytes of chronic human wounds and found C4.4A expression markedly upregulated in migrating keratinocytes during re-epithelisation of incisional skin wounds. Phorbol-ester-induced hyperplasia of mouse skin is also accompanied by a significant induction of C4.4A expression in the multilayered, suprabasal keratinocytes. C4.4A contains two Ly-6 (leucocyte antigen 6)/uPAR/alpha-neurotoxin modules. Our recombinant human C4.4A is extensively modified by post-translational glycosylation, which include 5-6 N-linked carbohydrates primarily located in or close to its second Ly-6/uPAR/alpha-neurotoxin module and approximately 15 O-linked carbohydrates clustered in a Ser/Thr/Pro-rich region at the C-terminus. A highly protease-sensitive region (Tyr200-Arg204) is located between these two clusters of N- and O-linked carbohydrates. The natural, glycolipid-anchored C4.4A from amnion membranes of human term placenta exhibits similar properties. Using recombinant, soluble C4.4A or MCF 7 cells, which express significant amounts of GPI-anchored C4.4A, we find no evidence for an interaction between C4.4A and uPA, a property suggested previously for rat C4.4A. Collectively these data indicate that C4.4A, although being a structural homologue of uPAR, is unlikely to have a functional overlap with uPAR.

Cryogenic sprays are used for cooling human skin during laser dermatologic surgery. In this paper, six straight-tube nozzles are characterized by photographs of cryogenic spray shapes, as well as measurements of average droplet diameter, velocity, and temperature. A single-droplet evaporation model to predict average spray droplet diameter and temperature is tested using the experimental data presented here. The results show two distinct spray patterns--sprays for 1.4-mm-diameter nozzles (wide nozzles) show significantly larger average droplet diameters and higher temperatures as a function of distance from the nozzle compared with those for 0.5-0.8-mm-diameter nozzles (narrow nozzles). These results complement and support previously reported studies, indicating that wide nozzles induce more efficient heat extraction than the narrow nozzles.

Dermatologists performing skin surgery mostly use the square knot. Other underused or even forgotten suturing techniques may still be helpful in some instances. We shall emphasize some simple techniques such as the horizontal mattress suture, the "cross stitch", the "corner stitch" (half buried mattress suture), the buried dermal suture, the buried vertical mattress suture, the continuous mattress suture and the running intradermal suture. In given circumstances, all of them may improve suturing and promote healing. Technical aspects, advantages and disadvantages of each type of suture will be briefly described., English Abstract, Journal Article, Review, info:eu-repo/semantics/published