How to Optimize Epidermal Approximation During Wound Suturing Using a Smartphone Camera.

Precise wound approximation during cutaneous suturing is of vital importance for optimal closure and long-term scar outcomes. Utilizing smartphone camera technology as a quality-control checkpoint for objective evaluation allows the dermatologic surgeon to scrutinize the wound edges and refine their surgical technique to improve scar outcomes.

Assessment of Donor Site Scar Outcomes, Healing Time, and Postoperative Complications Associated With Split Thickness Skin Grafts Harvested From the Hair Bearing Scalp.

BACKGROUND: The hair-bearing scalp is an underused donor site for split-thickness skin grafts (STSG). OBJECTIVE: Evaluating the donor site scar outcomes, healing times, and complications associated with STSG harvested from the hair-bearing scalp. MATERIALS AND METHODS: During this prospective observational study, donor site healing was assessed on postoperative Days 8 and 30. Donor site scar outcomes were quantified at 1 month using the Vancouver Scar Scale. All postoperative complications were collected during the 30-day follow-up window. RESULTS: 80% of donor sites was fully healed at 1-week follow-up. Vancouver Scar Scale score at the donor site was 0.26 at 1-month follow-up. All patients experienced full hair regrowth. Maximum pain scores were reported on the night of surgery (Vancouver Scar Scale 1.8), with quick resolution in days to follow. No major complications were reported. All STSG obtained from the scalp had full take and good texture and color match with the recipient site. CONCLUSION: The hair-bearing scalp is an excellent donor site for split-thickness skin graft harvesting.

Assessment of Pain, Healing Time, and Postoperative Complications in the Healing of Auricular Defects After Secondary Intent Healing Versus Split Thickness Skin Graft Placement.

BACKGROUND: Reconstruction of auricular defects after Mohs surgery is challenging given the prominence of the ear and its complex 3-dimensional architecture. OBJECTIVE: Evaluation of postoperative pain, healing time, and postoperative complications of auricular defects after split-thickness skin graft (STSG) placement versus secondary intent healing (SIH). MATERIALS AND METHODS: During this prospective, observational study, 30 patients recorded their daily maximum postoperative pain using the numeric pain rating scale from postoperative days 0 to 8. Surgical site healing was assessed at postoperative day 8 and 30. All postoperative complications were collected during the 30-day follow-up window. RESULTS: Patients undergoing STSG experienced significantly more pain during the first 3 postoperative days than patients in the SIH group. Maximum pain was experienced on the night of surgery, with a mean pain score of 3.6 in the STSG groups versus 0.8 in the SIH group. Healing was significantly faster in the STSG group, with 87% of patients fully healed at 1 week versus 21% in the SIH group. No major complications were experienced in either group. CONCLUSION: Split-thickness skin graft and SIH healing are well tolerated and provide excellent repair choices for auricular defects.

A Prospective, Randomized Controlled, Single-Blinded Study to Assess the Effect of a 33-Gauge Needle Versus a 34-Gauge Needle on Pain Experienced During Injection of Local Anesthetic on the Face.

BACKGROUND: Most pain experienced by patients during Mohs micrographic surgery is associated with the initial injection. Previous studies have shown that a smaller gauge needle (33-gauge vs 30-gauge) is associated with less patient-reported pain. OBJECTIVES: To evaluate patient-reported pain levels following injection with a 33-gauge versus a 34-gauge needle.  Methods: During this prospective, randomized, controlled, single-blinded study, 480 patients were randomized into a 33-gauge versus a 34-gauge needle group. Pain levels following needle insertion were recorded using the validated numerical rating scale (VNRS)-11 scale.  Results: Injection of local anesthetic with a 34-gauge needle is associated with significantly less pain compared to a 33-gauge needle across all subgroups (P=0.007, average pain level 0.49 [34-gauge group] vs 0.79 [33-gauge group] rated on a 0-10 pain scale). Females, first-time Mohs patients, patients under age 65, patients with basal cell carcinoma, and those with tumor locations on the nose experienced the most pain reduction with the use of a 34-gauge needle.  Limitations: This was a single-blinded study; thus, the injector was able to see which needle was being used. This knowledge could have subconsciously affected the angle, speed, or force used to insert the needle. CONCLUSIONS: Injections with a 33-gauge and a 34-gauge needle are both tolerated well and associated with minimal pain. While the pain reduction associated with using a 34-gauge needle is statistically significant, the use of a 34-gauge needle may be most clinically relevant for certain patient subgroups. J Drugs Dermatol. 2023;22(11): doi:10.36849/JDD.7689.

A patient with anti-NXP2-positive dermatomyositis and syphilis.

Dermatomyositis is an auto-immune inflammatory myopathy that primarily affects the skin and muscle and can be triggered by exposure to various environmental factors. We present a patient with active syphilis infection who developed dermatomyositis and discuss the significance of anti-NXP2 autoantibody positivity.