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Background: Surgical excision is a mainstay of treatment for non‐melanoma skin cancer (NMSC); improving margin delineation can reduce the need for further monitoring/treatment. The objective of this pilot study was to determine if near‐infrared radiation (NIR) application to skin causes visible changes in normal and NMSC skin, to help delineate margins. Materials/Methods: Eleven biopsy‐proven NMSC lesions were included. The skin was then heated under a 175W NIR heating bulb; margins were traced onto acetate film before and after heating. Lesions were then randomly assigned to excision based on pre‐ or post‐heating margins. Composite images were generated by overlaying the heat and no‐heat lesion contours. All specimens were sent for histopathology. Results: The range of closest margins in the control group was 2.0‐3.0 mm with a median of 2.0 mm; the range in the intervention group was 4.0‐9.0 mm with a median of 5.0 mm. Composite images showed larger heat contours when the initial lesion was larger. There was a statistically significant difference between the two groups. Overall, NIR light caused visible hyperaemia to skin, and more intense erythema to malignant skin lesions. Conclusion: Near‐infrared light may have use in an outpatient setting for skin cancer delineation, possibly reducing the rate of positive margins. [ABSTRACT FROM AUTHOR]

The process of learning new surgical technical skills is vital to the career of a surgeon. The acquisition of these new skills is influenced greatly by visual-spatial ability (VSA) and may be difficult for some learners to rapidly assimilate. In many cases, the role of VSA on the acquisition of a novel technical skill has been explored; however, none have probed the impact of a three-dimensional (3D) video learning module on the acquisition of new surgical skills. The first aim of this study is to capture spatially complex surgical translational flaps using 3D videography and incorporate the footage into a self-contained e-learning module designed in line with the principles of cognitive load theory. The second aim is to assess the efficacy of 3D video as a medium to support the acquisition of complex surgical skills in novice surgeons as evaluated using a global ratings scale. It is hypothesized that the addition of depth in 3D viewing will augment the learner's innate visual spatial abilities, thereby enhancing skill acquisition compared to two-dimensional viewing of the same procedure. Despite growing literature suggesting that 3D correlates directly to enhanced skill acquisition, this study did not differentiate significant results contributing to increased surgical performance. This topic will continue to be explored using more sensitive scales of measurement and more complex 'open procedures' capitalizing on the importance of depth perception in surgical manipulation. Anat Sci Educ. © 2012 American Association of Anatomists. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To determine the efficacy of interventions to improve and monitor skin scarring, a valid assessment instrument must be used. Current tools used for the evaluation of skin scarring employ equal appearing interval (EAI) scales that assume scar dimensions conform to linear models. Some scar features meet these assumptions, whereas others may not be accurately described. This study determined if current methods of scar evaluation validly characterize inherent features of scars, and in doing so, empirically validate if specific scar dimensions were best represented by linear or nonlinear mathematical models. Study Design: Prospective, randomized, cross-over trial. Methods: Twenty-seven observers evaluated 30 scar photos utilizing both EAI and direct magnitude estimation (DME) scaling methods. The method of scaling and the assessed dimensions of vascularity, pigmentation, thickness, pliability, and surface area were randomized. EAI and DME data were evaluated to identify whether each scar dimension conformed to linear or curvilinear mathematical models. Results: Best-fit analysis revealed the dimensions of vascularity and pigmentation to be more accurately described using curvilinear functions, whereas pliability, thickness and surface area were best defined using linear models. Conclusions: The scar dimension under assessment must be considered when attempting to validly apply an assessment instrument. Several commonly evaluated dimensions of skin scarring are not appropriately characterized using linear EAI scales. Thus, present assessment instruments must be revised to account for this aberration to allow for a valid means of objectively evaluating skin scarring. Laryngoscope, 2009 [ABSTRACT FROM AUTHOR]

Objective: This study assessed the utility of focused scar injury with an ink-free tattooing technique combined with UV light exposure for the treatment of hypopigmented cervicofacial scars. Study Design: Pilot prospective, randomized, control trial. Subjects: Individuals with long-standing hypopigmented cervicofacial scars. Methods: Twenty individuals randomly underwent UVA light exposure with or without dry tattooing. Scars were evaluated pretreatment and at seven-months post-treatment. Outcome measures included observer and patient subjective assessment of the scar, and objective evaluation of the erythema and melanin content of the scar and the surrounding skin. Results: The tattoo group demonstrated statistically significant improvement in the subjective evaluation of their scars. Scar melanin content reached equivalence with the surrounding skin. Observer and patient subjective global ratings support the use of dry tattooing. Conclusions: Dry-tattooing followed by UV light exposure may provide a safe and effective means for the treatment of hypopigmented scars. [Copyright &y& Elsevier]

Objective: This study assessed rhinometric improvement in nasal airflow, perceived comfort, and the utility of nasal dilation devices for individuals with nasal obstruction treated with an external nasal dilator (END) or a novel internal nasal dilation stent (INDS). Study Design: Prospective, randomized, crossover trial. Subjects: Individuals with symptoms of nasal obstruction. Methods: Twenty-three participants underwent rhinometry and a trial with a novel INDS and a validated END. Devices were used in a randomized, crossover fashion. Nasal airflow, maximum use, continuous use, comfort, and challenge with these devices were assessed. Results: The END and INDS showed greater nasal airflow from baseline, with the INDS being significantly better than the END. The INDS was used significantly more than the END, and demonstrated significantly greater comfort and less associated challenge. Conclusions: The novel INDS showed 3.4 times improved nasal airflow from baseline, was used maximally and continuously longer than a validated END, and was judged to be significantly more tolerable. [Copyright &y& Elsevier]

Objective: To evaluate changes in dermal characteristics with subdermal fat grafting of cutaneous scars. Design: Prospective cohort. Methods: Fourteen patients with various scar types were treated with subdermal fat grafting over 30 months. Dermal elasticity, vascularity, pigmentation, patient perception and satisfaction, and observer assessment of scar characteristics were evaluated preoperatively and 1 year after treatment with validated objective and subjective measures. Results: Significant improvements were observed in dermal elasticity, patient and observer perception of scar thickness, patient perception of stiffness, and observer perception of relief and pliability (P < 0.05). A trend toward significance was seen in observer assessment of height as evaluated by the Vancouver Scar Scale (P < 0.1). No significant differences were seen in quantitatively and qualitatively measured vascularity and pigmentation (P > 0.1). No significant difference in pain, pruritis, and irregularity were reported (P > 0.1). Conclusion: Although fat grafting represents a subdermal process, it appears to improve certain quantitative and qualitative dermal characteristics. Fat grafting does not appear to affect skin color, vascularity, or patient symptoms. [Copyright &y& Elsevier]

Objective: It is proposed to test the practicality of septopalatal protraction in the unilateral cleft palate infant for purposes of straightening the nasal septum and thus relieving nasal airflow obstruction and its detrimental sequelae. Methods: Alternate infants affected with complete unilateral palatal clefts had septopalatal protraction for a period of 6 to 8 weeks (protraction group; n = 4). Septal deviation was measured by a standardized technique that used computed tomography scans. The remaining infants had no protraction and served as controls (nonprotraction group; n = 5). Septal deviation was measured in the nonprotraction group from palatoseptal dental molds. Results: A total of 9 patients were studied. All patients in the nonprotraction group had worsening of nasal septal deviation over a period of 8 weeks compared with the protraction group, which had complete nasal septal straightening. Differences in septal angle deviation between the protraction group and nonprotraction group at the end of the study were statistically significant (P ≤ 0.01) as measured by the paired Student t test. Conclusions: Septopalatal protraction in the newborn appears to provide a means for correcting nasal septal deviation in complete unilateral cleft palate infants. Septopalatal protraction in the newborn is relatively easy and safe. EBM rating: B-2 [Copyright &y& Elsevier]