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The association between cigarette smoking and necrosis of flaps and full-thickness grafts was analyzed in 220 patients. Review of a series of 916 flaps and full-thickness grafts revealed 44 patients in whom some degree of tissue necrosis occurred. These patients with necrosis were age and gender matched with 176 controls randomly selected from the remaining 872 patients. Current high-level smokers, that is those smoking one or more packs per day, had necrosis develop approximately three times more frequently than never smokers, low-level smokers (less than one pack per day), or former smokers (95% confidence interval, 1.2 to 8.2). Former smokers (relative risk, 1.4; 95% confidence interval, 0.6 to 3.2) and low-level smokers (relative risk, 1.1; 95% confidence interval, 0.2 to 6.1) were at a negligible increased risk for necrosis that was not significantly different from never smokers. Once tissue necrosis developed, the median percent of the visible flap or graft tissue that necrosed was approximately threefold greater among current smokers (regardless of the number of packs per day smoked) than never smokers.

Electrodesiccation and electrocoagulation are commonly used to control bleeding and destroy tissue. In certain outpatient settings, the clinician routinely uses one of these electrosurgical modalities on successive patients without sterilization or antisepsis of the treatment electrode tip. In controlled laboratory experiments using electrodesiccation and electrocoagulation, we investigated bacterial transference of Staphylococcus aureus from inoculated tissue to sterile electrode tips and from inoculated electrode tips to sterile tissue. With use on inoculated tissue, sterile electrode tips remained sterile after electrocoagulation but not after electrodesiccation. Bacterial transference from inoculated electrode tips to sterile tissue occurred with electrodesiccation but not with electrocoagulation. These results are consistent with bacterial destruction by electric current and suggest that bacterial transference via the treatment electrosurgery electrode from one patient to another is possible but much more probable during electrodesiccation than during electrocoagulation.

A 57-year-old man with asymptomatic pancreatitis developed tender subcutaneous nodules with fat necrosis. These nodules were the sole clinical manifestation of the underlying disease. This case demonstrates that silent pancreatitis should be considered in the differential diagnosis of painful leg nodules.

Sixty-nine primary basal cell carcinomas were treated by curettage and electrodesiccation three times, and subsequently, excised tissue was analyzed for microscopic persistence of tumor. We found persistent tumor in 33.3% of cases overall. Of 45 lesions on the head, residual tumor was detected microscopically in 46.6%, whereas of 24 lesions on the trunk and extremities, residual tumor was found in only 8.3%. This difference was statistically significant, even though the average precurettage and postcurettage sizes of the lesions in these two groups were comparable. Therefore, we conclude that basal cell carcinomas are more resistant to ablation with curettage and electrodesiccation on the head than on the trunk or extremities.

A 0.25-mL quantity of 0.25%, 0.5%, and 1.0% polidocanol (Aethoxysclerol [France]), 0.5% sodium tetradecyl sulfate (Sotradecol injection), and 23.4% hypertonic saline was injected into the dorsal marginal rabbit ear vein; clinical and histologic thrombosis resulted that lasted between four and eight days. The lowest concentration of polidocanol (0.25%) demonstrated immediate thrombosis; however, no clinical or histologic changes occurred eight days after injection. With all other agents, histologic fibrosis of the vessel correlating with clinical disappearance occurred after eight days. However, 0.5% polidocanol and sodium tetradecyl sulfate developed recanalization through the initially sclerosed vessel between eight and 14 days, with clinical reappearance of the 0.5% polidocanol-injected vessel at 30 days, after injection. Cutaneous necrosis was noted clinically and histologically in three of ten vessels injected with 1.0% polidocanol and in two of ten vessels injected with hypertonic saline. Clinical and histologic evidence of necrosis occurred with and without extravasation of the sclerosants.