A novel foil flip-over system as the final layer in wound closure: excellent cosmetic results and patient comfort.

BACKGROUND: Wound closure after excision is commonly done with sutures or staples. A new sutureless innovative wound closure system is available for sutureless skin closure. OBJECTIVE: To evaluate wound healing, patient comfort, and cosmetic results of a foil flip-over system for excision of small skin lesion. MATERIALS AND METHODS: Patients presenting to the department of Dermatology of Erasmus University Medical Center, Rotterdam, The Netherlands for skin surgery during a 1.5-year period were prospectively studied. Key outcome measures were wound healing, patient comfort, and cosmetic results. Three independent physicians scored photographs of the scars. Evaluation tools used were comfort and body image questionnaires and visual analogue scales. RESULTS: Ninety-six patients with 103 lesions were included in our study. The surgeon scored wound healing as excellent or good in 96%. No wound infections occurred. Ninety-two percent of patients scored removal of the system as comfortable. Median patient grade of scar after 1 month was 8 out of 10 points (interquartile range [IQR] 7-9). Median independent physician grade of photographs of the scars was 7.7 (IQR 7.1-8.0). CONCLUSION: Sutureless foil flip-over is promising, with excellent patient comfort characteristics and good to excellent cosmetic results.

Interstitial radiation therapy for early-stage nasal vestibule cancer: a continuing quest for optimal tumor control and cosmesis.

INTRODUCTION: This article reports on the effectiveness, cosmetic outcome, and costs of interstitial high-dose-rate (HDR) brachytherapy for early-stage cancer of the nasal vestibule (NV) proper and/or columella high-dose-rate (HDR). METHODS AND MATERIALS: Tumor control, survival, cosmetic outcome, functional results, and costs were established in 64 T1/T2N0 nasal vestibule cancers treated from 1991-2005 by fractionated interstitial radiation therapy (IRT) only. Total dose is 44 Gy: 2 fractions of 3 Gy per day, 6-hour interval, first and last fraction 4 Gy. Cosmesis is noted in the chart by the medical doctor during follow-up, by the patient (visual analog scale), and by a panel. Finally, full hospital costs are computed. RESULTS: A local relapse-free survival rate of 92% at 5 years was obtained. Four local failures were observed; all four patients were salvaged. The neck was not treated electively; no neck recurrence in follow-up was seen. Excellent cosmetic and functional results were observed. With 10 days admission for full treatment, hospital costs amounted to euro5772 (7044 US dollars). CONCLUSION: Excellent tumor control, cosmesis, and function of nasal airway passage can be achieved when HDR-IRT for T1/T2N0 NV cancers is used. For the more advanced cancers (Wang classification: T3 tumor stage), we elect to treat by local excision followed by a reconstructive procedure. The costs, admission to hospital inclusive, for treatment by HDR-IRT amounts to euro5772 (7044 US dollars). This contrasts substantially with the full hospital costs when NV cancers are treated by plastic reconstructive surgery, being on average threefold as expensive.

Nasal reconstruction after malignant tumor resection: an algorithm for treatment.

BACKGROUND: Seventy-five percent of nonmelanoma skin cancers are located in the head and neck area, of which 30 percent occur on the nose (225,000 new cases per year). The aim of this study was to develop a nasal reconstruction algorithm for nasal defects, based on experience with 788 consecutive nasal reconstructions performed in a multidisciplinary university medical center setting over a period of 7 years. METHODS: Medical files of 788 consecutive patients who were operated on for various nasal pathologies between January of 2001 and December of 2008 were reviewed. In addition, a literature search on treatment of nasal defects and outcomes after nasal reconstruction was conducted using PubMed. RESULTS: The algorithm divides nasal defects into simple, small (skin only), larger (skin and cartilage), or full thickness. Small defects can be closed primarily or with various local flaps. For larger defects, the three-stage paramedian forehead flap is the flap of choice with or without the use of cartilage grafts. For small inner lining defects, full-thickness skin grafts or turn-down lining flaps with delayed primary cartilage grafts at the intermediate stage are currently the authors' preference. For medium to larger inner lining defects, the folded forehead flap with delayed primary cartilage grafts at the intermediate stage is the authors' preferred technique. For (sub)total nasal reconstructions with very large inner lining requirements, the authors would now consider free vascularized tissue transfer. CONCLUSIONS: Nasal skin cancer is an increasing problem. Proper treatment of nasal skin cancer, including nasal reconstruction, requires a structured multidisciplinary approach to achieve excellent tumor control and a satisfactory aesthetic and functional end result.

Topical 5-aminolevulinic acid mediated photodynamic therapy of superficial basal cell carcinoma using two light fractions with a two-hour interval: long-term follow-up.

Photodynamic therapy (PDT) of superficial basal cell carcinoma using topical 5-aminolaevulinic acid (ALA) and 75-100 J/cm2 light dose yields unsatisfactory long-term results. In several animal models, illumination with two light fractions approximately 2 h apart was considerably more effective than single illumination, suggesting the need for a pilot clinical study. Fifteen patients with a total of 86 primary superficial basal cell carcinomas, received topical ALA and were illuminated 4 and 6 h later, both with 45 J/cm2 laser light (633+/-1 nm). Fluorescence spectra were measured before and immediately after each illumination. At a mean follow-up of 59 months (range 44-82), 67 lesions could be evaluated, 56 of which showed a complete response (84%). Cosmesis was good/excellent in 88% of the complete response group and fair in 12%. There was no correlation between protoporphyrin fluorescence and response, but a significant correlation between the percentage of fluorescence left after photobleaching by the first illumination and the amount of protoporphyrin re-synthesized 2 h later. In conclusion, the long-term complete remission rate of fractionated ALA-mediated PDT of superficial basal cell carcinoma as reported here is significantly better than after PDT with single illumination previously reported by others, but equal to studies using single illumination with a much higher light fluence. Further improvement may be possible by reducing the fluence of the first fraction, with constant total fluence.