Asunto(s)
Técnicas de Sutura , Dioxanos , Humanos , Cirugía de Mohs , Selección de Paciente , Poliésteres , Poliglactina 910/uso terapéutico , SuturasRESUMEN
BACKGROUND: Colonization with methicillin-resistant Staphylococcus aureus (MRSA) places patients at risk for postoperative MRSA wound infections. OBJECTIVE: To determine the effect of a decontamination and prophylaxis protocol on postoperative MRSA wound infections in patients with nasal MRSA. METHODS & MATERIALS: Wound cultures over a 23-month period were reviewed before and 11 months after implementation of a screening and decontamination protocol. After preoperative MRSA screening with nasal swabs, carriers were instructed to use intranasal mupirocin for 5 to 7 days before surgery and 5 to 7 days of trimethoprim-sulfamethoxazole starting the day before surgery. RESULTS: During the 23 months before prescreening evaluation, we performed 3,633 Mohs surgical cases, and 12 postoperative MRSA wound infections (0.3%) occurred. Subsequently, 963 patients underwent screening for MRSA, and 23 MRSA carriers were identified (2.4%). Of the 22 who underwent the decontamination and treatment protocol, none developed postoperative wound infections. One MRSA carrier did not receive preoperative treatment and subsequently developed a MRSA wound infection. There were no other MRSA infections. CONCLUSION: Preoperative MRSA screening and implementation of a decontamination protocol appears to decrease postoperative MRSA wound infections after Mohs surgery. Although an interesting observation, controlled studies of clinical and cost effectiveness are required before general implementation. The authors have indicated no significant interest with commercial supporters.
Asunto(s)
Control de Infecciones/métodos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Cirugía de Mohs/efectos adversos , Cuidados Preoperatorios/métodos , Infecciones Estafilocócicas/prevención & control , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/prevención & control , Administración Tópica , Antibacterianos/administración & dosificación , Profilaxis Antibiótica , Portador Sano/diagnóstico , Descontaminación/métodos , Hospitales de Veteranos , Humanos , Tamizaje Masivo/métodos , Mupirocina/administración & dosificación , Estudios Retrospectivos , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiologíaRESUMEN
BACKGROUND: Surgical evaluation of longitudinal melanonychia requires biopsy of the nail matrix. Previous publications have presented detailed surgical approaches to this problem. However, discussion of longitudinal excision with local matrix flap reconstruction is documented sparsely in the literature. OBJECTIVE: To describe the indications for and technique of performing a longitudinal, full-thickness excision for longitudinal melanonychia; as this surgery poses a high risk of postoperative split nail, reconstruction is essential. Three local matrix flaps are detailed to maximize functional and cosmetic results. METHODS: The authors detail the different procedures, with several illustrations and clinical photographs highlighting the techniques. RESULTS: These techniques provide the surgeon with additional approaches to excise lesions of longitudinal melanonychia and reconstruct the surgical defects. LIMITATIONS: All surgeries of the nail matrix pose a risk of postoperative nail dystrophy and/or split nail. CONCLUSION: The different flaps provide elegant local alternatives to second-intention healing and maximize cosmetic and functional results after matrix excision with narrow margins for longitudinal melanonychia.
Asunto(s)
Melanosis/cirugía , Enfermedades de la Uña/cirugía , Colgajos Quirúrgicos , Algoritmos , Humanos , Melanosis/patología , Enfermedades de la Uña/patología , Procedimientos Quirúrgicos Operativos/métodosRESUMEN
The skin changes reported in patients with end-stage renal disease (ESRD) are diverse and manifold. In this article we focus on a collection of specific cutaneous entities seen most frequently in the setting of ESRD, each presenting with distinctive and unique morphology. These include perforating disorders, porphyria cutanea tarda, pseudoporphyria, calcinosis cutis, calciphylaxis, and nephrogenic systemic fibrosis. The clinical features, histopathology, pathophysiology, differential diagnosis, and management of each entity are reviewed.
Asunto(s)
Fallo Renal Crónico/complicaciones , Enfermedades de la Piel , Diagnóstico Diferencial , Humanos , Prevalencia , Factores de Riesgo , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/epidemiología , Enfermedades de la Piel/etiología , Estados Unidos/epidemiologíaRESUMEN
Successful nail surgery requires exposure of the underlying tissues. In many cases, partial nail plate avulsion is preferable compared with traditional total distal and proximal plate avulsions. The techniques described herein include partial distal, lateral, proximal, and window techniques, and two variation of the total plate avulsion termed the trap door and lateral nail plate curl avulsion. By using these methods, the surgeon is able to access the targeted nail unit while minimizing trauma to adjacent, uninvolved tissue.