The Paramidline Forehead Flap: A Clinical and Microanatomic Study.

BACKGROUND: The traditional paramedian forehead flap (FHF) is an axial flap based on the supratrochlear artery (STA). Doppler examination is often used to ensure inclusion of the STA within the flap. The authors hypothesized that a FHF pedicle design could be simplified to extend from the midline of the glabella to 1.2 cm lateral to the midline without compromising outcomes. OBJECTIVE: To compare clinical outcomes and vessel densities of 2 FHF designs. METHODS: Two FHF designs were used to repair fifty nasal defects. One was based on Doppler identification of the STA; the other on clinical measurements from the glabellar midline (with no effort to identify the STA). Clinical outcomes, complication rates, and pedicle vasculature of both groups were compared. RESULTS: There was no significant difference in flap survival or complication rate. Forehead flaps designed on the paramidline glabella had more arteries within their pedicles than Doppler-based FHFs (p < .05). Small arteries predominated, whereas larger arteries were infrequent in both groups. Size and number of arteries were not related to flap survival. CONCLUSION: A paramidline FHF has equivalent clinical outcomes as a flap based on the STA. A simple and reproducible design of the FHF using only surface landmarks is described.

Mohs versus traditional surgical excision for facial and auricular nonmelanoma skin cancer: an analysis of cost-effectiveness.

OBJECTIVE: To evaluate and compare Mohs micrographic surgery and traditional excision in terms of cost and outcomes. DESIGN: We developed a computer-simulation, probabilistic, decision model to perform a cost-effectiveness analysis, with each patient serving as his or her own control. SETTING: University of Connecticut dermatology clinic, a tertiary care referral center. PARTICIPANTS: Input data were derived from results of a consecutive sample of 98 patients with nonmelanoma skin cancer on the face and ears, estimates in the literature on 5-year recurrence rates, and a query of healthy focus-group participants. INTERVENTION: We considered Mohs and traditional excision strategies. MAIN OUTCOME MEASURES: Outcomes were measured in quality-adjusted life years, cost, and cost-effectiveness. RESULTS: The Mohs strategy was $292 less expensive than the traditional surgical strategy and was more effective by an incremental quality-adjusted life year of 0.056 (translating to approximately 3 weeks of optimal quality of life). Results were robust to subgroup and sensitivity analyses. CONCLUSIONS: Mohs may be more cost-effective than traditional excision in eradicating nonmelanoma skin cancer. Further investigation of costs from various geographic payment localities and assessment of quality-of-life outcomes from a population-based sample are needed.

Interferon Alfa-2b or not 2b? Significant differences exist in the decision-making process between melanoma patients who accept or decline high-dose adjuvant interferon Alfa-2b treatment.

BACKGROUND: Patients with thick (Breslow>4 mm) primary melanoma and/or regional nodal metastasis have a high risk of tumor recurrence. High-dose adjuvant interferon (IFN) alfa-2b offers/=50% risk of recurrence/disease-related mortality and offered IFN. Telephone surveys delineated reasons behind patients' decisions to accept IFN. RESULTS: Acceptors, 60 of 135 (45%), decided to take IFN alfa-2b whereas 75 of 135 (55%) declined. Being female (OR, 2.4; 95% CI, 1.17-5.03; p=.017) and positive SLN status (OR, 2.2; 95% CI, 1.01-4.97; p=.048) were strongly associated with patients who chose IFN. Acceptors of IFN were younger, more influenced by physicians, and less affected by depression and side effect profile (p<.05 for all). Decliners were more concerned by strained relationships with family and social life (p<.05). CONCLUSIONS: Gender and positive SLN were predictive of high-risk melanoma patients' acceptance of IFN treatment. Physician insight into melanoma patients' therapeutic decision-making process can guide patients through this difficult disease.