Prospective Study of Wound Infections in Mohs Micrographic Surgery Using a Single Set of Instruments.

BACKGROUND: Mohs micrographic surgery (MMS) has a low rate of surgical site infections (SSI). To date, there are variations in the measures surgeons take to prevent SSI, although these may be costly without benefit to patients. OBJECTIVE: The purpose of the study was to evaluate the rate of SSI in MMS performed with a clean technique using a single set of instruments for both tumor extirpation and reconstruction. MATERIALS AND METHODS: The author prospectively evaluated 338 patients undergoing MMS using a single set of instruments for SSI. RESULTS: There were 7 SSI among 332 patients, with an overall infection rate of 2.1% (7/332). Graft closures had an SSI rate of 3.1% (2/64) and flap closures had an SSI rate of 1.9% (5/268). CONCLUSION: Using a single set of sterile surgical instruments for both the tumor extirpation and repair stages of MMS leads to cost savings without harming patients and maintains SSI rates within an acceptable range.

Partially involuting congenital hemangiomas: a report of 8 cases and review of the literature.

BACKGROUND: Congenital hemangiomas have been divided into 2 major subtypes based on clinical behavior: rapidly involuting congenital hemangioma (RICH) and noninvoluting congenital hemangioma (NICH). OBJECTIVE: We describe a clinical subtype of congenital hemangioma that begins as a RICH but fails to completely involute and persists as a NICH-like lesion. We propose the term "partially involuting congenital hemangioma" for this lesion with overlapping features. METHODS: A review of the medical charts, serial clinical photographs, imaging, and biopsies performed on children with a diagnosis of partially involuting congenital hemangioma between 2001 and 2012 at Centre Hospitalier Universitaire Sainte-Justine pediatric dermatology/vascular anomalies clinic was performed. RESULTS: Eight full-term, healthy infants presented at birth with vascular lesions typical of RICH. Affected locations included the head and neck, trunk, or extremities. Size varied from 2.0 × 1.5 cm to 13.0 × 8.5 cm. All had rapid involution during the first 12 to 30 months of life before stabilizing in size and appearance. LIMITATIONS: Only a small number of cases were identified. CONCLUSION: Partially involuting congenital hemangiomas are congenital hemangiomas with a distinct behavior, evolving from RICH to persistent NICH-like lesions. Their recognition and study will help us better understand whether RICH and NICH are indeed separate entities or simply part of a spectrum.

Gluteal Augmentation With Liquid Silicone of Unknown Purity Causes Granulomas in an Adult Female: Case Report and Review of the Literature.

BACKGROUND: A 39-year-old woman presented with a history of relapsing painful erythema and progressive fibrosis of the lower back. Upon questioning, the patient admitted to receiving liquid silicone (LS) injections for gluteal augmentation abroad and was diagnosed with silicone migration, granulomatous reaction, and fibrosis of the lower back. OBJECTIVE: To review the history of LS injections for cosmetic soft tissue augmentation (STA) as well as its complications and potential treatments. METHODS: The author reviewed articles that involved the use of LS for STA and summarized their findings. RESULTS: The author summarizes the various treatments that have been described for inflammatory reactions following LS injection. CONCLUSION: The growth of cosmetic medical tourism and its inherent lack of after-care as well as patients' ability to obtain restricted products at home raise the likelihood of encountering granulomatous or fibrotic reactions to fillers during consultations. Physicians should have a structured approach to these patients.

Disciplinary and Legal Actions Against Dermatologists in Canada.

BACKGROUND: Dermatologists face a litany of professional and legal risks in practice. OBJECTIVE: To review cases of disciplinary and legal action against dermatologists in Canada. METHODS: The Canadian Medical Protective Association, all 10 provincial medical colleges, and the Canadian Legal Information Institute were contacted to obtain data on legal or disciplinary action taken against dermatologists in their records. A literature review was performed regarding litigation against dermatologists in other countries. RESULTS: Six dermatologists in Canada faced disciplinary action in the last 5 to 30 years. Seven dermatologists and 5 other specialists in Canada faced lawsuits relating to dermatology in the last 1 to 144 years. Procedures and therapy are the most frequently sources of lawsuits against dermatologists both at home and abroad. CONCLUSION: Dermatologists need to remain vigilant to avoid disciplinary action and lawsuits from their increasing and varied interactions with patients.

Crescentic Back Cut: A Novel Technique for the Management of Flap/Defect Discrepancies in Rotation Flaps.

BACKGROUND: Facial reconstruction requires the use of various techniques to repair cutaneous defects. Sliding flaps, such as advancement and rotation flaps, typically result in tension alterations and skin redundancy, necessitating a secondary defect. OBJECTIVE: We describe a back cut technique that allows minimization of the scar line and appropriate placement of tension vectors in certain locations, which we call the crescentic back cut. METHODS: A patient with a surgical defect on his preauricular cheek is repaired by use of a rotation flap modified with a crescentic back cut. We briefly review the alternative methods for management of flap/defect discrepancies in rotation flaps. RESULTS: The crescentic back cut is simple to suture, can be adjusted in length and thickness to minimize pedicle transection, and keeps the scar short and within the relaxed skin tension lines. CONCLUSION: The crescentic back cut is a useful option to manage flap/defect discrepancies in rotation flaps.

Rosai-Dorfman disease treated with methotrexate and low-dose prednisone: case report and review of the literature.

BACKGROUND: Rosai-Dorfman disease is a rare condition characterized by an accumulation of histiocytes within lymph nodes and tissue. Treatment is indicated when the condition is highly symptomatic and when widespread involvement causes vital organ compression. OBJECTIVE: To review the classic physical and histologic findings in Rosai-Dorfman disease and summarize the literature supporting the use of methotrexate in this condition. METHODS AND RESULTS: We describe a case of Rosai-Dorfman disease that failed to respond to monotherapy with systemic corticosteroids but improved with the addition of methotrexate. Methotrexate alone or in combination with other agents has been described in at least 12 other cases in the literature and lead to a partial or complete resolution of disease in over half of these. CONCLUSION: The rapid improvement of clinical and physical symptoms with minimal side effects in our case and others reinforces the utility of antimetabolites in patients with Rosai-Dorfman disease who fail to respond to corticosteroids.

Physician survey regarding patient nonattendance at follow-up appointments at a university-affiliated medical dermatology clinic.

BACKGROUND: Patient nonattendance is a frequent occurrence in dermatology clinics, and our responsibility regarding the follow-up of these patients remains nebulous. OBJECTIVE: This study sought to evaluate the beliefs and practices of physicians at a university-affiliated medical dermatology clinic regarding patient nonattendance at follow-up appointments and to provide an algorithm to deal appropriately with absentee patients based on various Canadian medical association guidelines. METHODS: A questionnaire was distributed to the 17 dermatologists practicing at the Centre Hospitalier de l'Université de Montréal medical dermatology clinic. We contacted provincial and national medical associations regarding directives for patient follow-up. RESULTS: There is a lack of consensus among dermatologists at the Centre Hospitalier de l'Université de Montréal regarding responsibility toward patients who miss their follow-up appointments. However, the majority of survey respondents consider that patient follow-up must be adjusted on a case-by-case basis and that diagnoses at risk for high morbidity and mortality require particular attention, which is in line with various Canadian medical association guidelines. CONCLUSION: Dermatologists should have a structured approach to dealing with patients who miss their follow-up appointments to ensure the appropriate care of all patients.