Bishop Flap and Sigma Flap to Repair Surgical Defects in High-Tension Anatomical Regions. / Colgajo obispo y colgajo sigma para defectos quirúrgicos en zonas anatómicas de elevada tensión.

BACKGROUND: The reconstruction of surgical defects in high-tension anatomical regions is challenging due to the ischemia and subsequent necrosis associated with tension closure. Research on new flaps capable of closing these defects exerting less tension would be a tremendous advancement in dermatological surgery. PATIENTS AND METHODS: We conducted a multicenter, retrospective study that used 2 new flaps-the bishop and the sigma ones-to repair surgical defects in high-tension regions such as the scalp, lower extremities, and the nasal pyramid. The bishop flap was used in 9 patients, 5 of whom exhibited their lesion in the nasal pyramid, 2 in the legs and another 2 in the scalp. The sigma flap was used in 6 patients, 5 of whom exhibited scalp lesions and 1 leg lesion. RESULTS: Uneventful and excellent results were obtained in all 15 patients due to infection, dehiscence, or necrosis. CONCLUSIONS: Both the bishop and the sigma flaps are a good alternative to repair surgical defects in high-tension regions such as the scalp, lower extremities, or the nasal pyramid.

Cutaneous reactions after SARS-CoV-2 vaccination: a cross-sectional Spanish nationwide study of 405 cases.

BACKGROUND: Cutaneous reactions after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are poorly characterized. OBJECTIVE: To describe and classify cutaneous reactions after SARS-CoV-2 vaccination. METHODS: A nationwide Spanish cross-sectional study was conducted. We included patients with cutaneous reactions within 21 days of any dose of the approved vaccines at the time of the study. After a face-to-face visit with a dermatologist, information on cutaneous reactions was collected via an online professional survey and clinical photographs were sent by email. Investigators searched for consensus on clinical patterns and classification. RESULTS: From 16 February to 15 May 2021, we collected 405 reactions after vaccination with the BNT162b2 (Pfizer-BioNTech; 40·2%), mRNA-1273 (Moderna; 36·3%) and AZD1222 (AstraZeneca; 23·5%) vaccines. Mean patient age was 50·7 years and 80·2% were female. Cutaneous reactions were classified as injection site ('COVID arm', 32·1%), urticaria (14·6%), morbilliform (8·9%), papulovesicular (6·4%), pityriasis rosea-like (4·9%) and purpuric (4%) reactions. Varicella zoster and herpes simplex virus reactivations accounted for 13·8% of reactions. The COVID arm was almost exclusive to women (95·4%). The most reported reactions in each vaccine group were COVID arm (mRNA-1273, Moderna, 61·9%), varicella zoster virus reactivation (BNT162b2, Pfizer-BioNTech, 17·2%) and urticaria (AZD1222, AstraZeneca, 21·1%). Most reactions to the mRNA-1273 (Moderna) vaccine were described in women (90·5%). Eighty reactions (21%) were classified as severe/very severe and 81% required treatment. CONCLUSIONS: Cutaneous reactions after SARS-CoV-2 vaccination are heterogeneous. Most are mild-to-moderate and self-limiting, although severe/very severe reactions are reported. Knowledge of these reactions during mass vaccination may help healthcare professionals and reassure patients.

Safety in Dermatologic Procedures: Vascular Occlusion by Filling Materials. / Seguridad en los procedimientos dermatológicos: oclusión vascular por materiales de relleno.

Ischemic events are the most serious complications of facial antiaging treatment with dermal fillers. Ischemia can cause Nicolau syndrome, blindness, or even stroke. This article discusses how to prevent ischemic complications and what steps to take should a dermatologic emergency develop. A thorough understanding of facial anatomy is important. Preferred procedural techniques involve the use of cannulas and retrograde injection. When ischemia is detected in the skin, hyaluronidase should be injected, preferably through a cannula. If ocular ischemia occurs, the patient should be transferred to a hospital with stroke code activation.

[Influence of anxiety in diverse cutaneous diseases]. / Influencia de la ansiedad en diversas patologías dermatológicas.

INTRODUCTION: The objective of the current study is to determine the levels of anxiety in patients with dermatological diseases compared to healthy subjects and the degree of anxiety in the different cutaneous diseases. MATERIAL AND METHODS: It is a descriptive study of a case series where 152 patients are selected, 20 of whom are healthy controls and the other 132 are patients that attend a Dermatology clinic. The patients are divided into 5 groups based on the cutaneous disorder for which they attend the clinic: chronic urticaria, acute urticaria, plaque psoriasis, atopic dermatitis, and a miscellaneous group (includes several diagnoses such as seborrheic keratosis, follow-up of multiple nevi, carcinomas...) where, a priori, anxiety does not influence these disorders. Spielberger State-Trait Anxiety Inventory (STAI) is administered to the participating subjects and the differences in State Anxiety Inventory (SAI) and Trait Anxiety Inventory (TAI) for the different groups are analyzed. Patients were asked to report any stressful event in the six months prior to the appearance of the disease that might have been a trigger, and they were also asked about history of psychiatric disorders or atopy. RESULTS: We observed significant differences in the means obtained in SAI and TAI in healthy subjects compared to patients. We obtained higher mean scores in SAI in patients diagnosed of atopic dermatitis, that were significant when compared with patients with chronic urticaria or other diseases. Forty-eight percent of patients with psoriasis and 38.89 % of patients with atopic dermatitis report a stressful event in the past six months compared to 11.54% of patients from the group with miscellaneous diseases and, additionally, patients with psoriasis and atopic dermatitis have the highest mean scores in the anxiety tests. Twenty-one percent of the 132 patients with cutaneous diseases report a history of psychiatric disorders, showing statistically significant higher mean scores in STAI. CONCLUSION: The findings show the comorbidity of psychiatric disorders in patients with chronic cutaneous diseases and the high levels of state and trait anxiety, mainly in patients with psoriasis and atopic dermatitis.