Needling for the Treatment of Warts.

Needling is a technique for the treatment of warts that is widely unknown and underused within dermatology. Gordon Falknor, a podiatrist, first introduced the technique of needling for the treatment plantar warts in 1969. He reported only two recurrences in 126 patients treated with his technique. Falknor's technique involves using a hollow needle to repeatedly penetrate the base of a wart, into the subcutaneous tissue, until there is no longer resistance to puncturing. Needling causes extensive destruction of keratinocytes and the release of high levels of viral protein into the surrounding tissue. Deep penetration of this viral protein into the subcutaneous tissue increases the likelihood of developing a systemic immune response against the virus, which often results in the resolution of both satellite and distant warts in addition to the treated primary wart. Since Falknor's original study, there have been few studies on needling for warts. Despite the paucity of literature, needling appears to be a low-risk, inexpensive, and effective treatment for warts, especially in patients with extensive or refractory disease on the hands and feet.

Incidence of Surgical Site Infections in Second Intention Healing After Dermatologic Surgery.

BACKGROUND: There are few studies analyzing the surgical site infection (SSI) rate of second intention wounds after dermatologic surgery, and the results are inconclusive. Yet, the current dogma in dermatologic surgery is that wounds healed by second intention have lower infection rates. OBJECTIVE: To determine the rate of SSI and associated pathogenic organisms of second intention wounds compared with sutured wounds after skin cancer extirpation. MATERIALS AND METHODS: This was a retrospective cohort study of patients who had either Mohs micrographic surgery or wide local excision (WLE) for skin cancer extirpation between 2012 and 2016. Wounds were stratified by closure type, location, and associated organisms. Infection was diagnosed by a positive wound culture. RESULTS: The overall infection rate was 3.9%. The infection rate for sutured and second intention wounds was 3.2% and 6.8%, respectively. Second intention wounds were associated with a significantly higher risk of infection compared with sutured wounds (odds ratio = 2.22, 95% confidence interval 1.63-2.99). The lower extremity (LE) had the highest overall infection rate (10.5%). The face had the lowest overall infection rate (2.5%). CONCLUSION: Mohs micrographic surgery or WLE performed on the LE or lesions allowed to heal by second intention has an increased risk of SSI.