Current status of surgery in dermatology.

An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein.

Case series: evaluation of a liquid silicone gel on scar appearance following excisional surgery--a pilot study.

Efforts to improve the size and appearance of scars have included therapies as varied as laser treatments and onion extract gels. Silicone gel sheeting is well know to improve the appearance of hypertrophic scars, and may have a role in the management of routine surgical and traumatic scars. By varying the degree of cross linking, silicone elastomer can be a solid sheet or a liquid gel. In this pilot series, seven patients applied a liquid silicone gel twice a day to one half of a new surgical scar for three months. At the end of this time, the treated side was noticeably better in appearance in five of seven patients while two of seven had no difference. In no patient was the silicone treated side worse in appearance.

Correction of atrophic scars with artefill: an open-label pilot study.

BACKGROUND: Artefill, a novel permanent filler approved by the U.S. Food and Drug Administration (FDA), has been used as an injectable implant for the correction of nasolabial folds. Fillers are considered a first line treatment for atrophic scars. OBJECTIVE: The authors evaluated the degree of correction and subject satisfaction of correction of atrophic acne scar(s) after injection of Artefill. METHODS: Fourteen qualified subjects participated in a single-center, open-label, pilot study. Atrophic acne scars were evaluated prior to injection. Subscision was performed, and then Artefill was injected into the scar. The degree of improvement was measured at weeks 2 and 4 and month 8. Subjects were asked to fill out a satisfaction survey at their eight-month visit. RESULTS: Investigator ratings after eight months post procedure indicated that 96 percent of the atrophic acne scars showed some degree of improvement. There was no improvement in two out of a total of 57 scars evaluated. The majority of patients reported a moderate correction, correlating with a 51-75 percent improvement in their acne scars at eight months. No adverse events or side effects were noted. CONCLUSION: Artefill demonstrated to be both an efficacious and safe therapy for the treatment of atrophic acne scars.

Clinical aspects of full-thickness wound healing.

Optimal management of full-thickness wounds requires a thorough knowledge of wound-healing principles and practices. In the absence of underlying disease, almost every full-thickness wound will heal with minimal intervention; however, the process can be enhanced by judicious wound management. The first clinical decision to be made is whether to repair the wound or to allow it to heal by second intention. This decision is guided by a host of objective and subjective factors. Reconstruction options include primary closure, flaps, and grafts. Materials to aid reconstruction, including the introduction of tissue adhesives, continue to evolve. Both primary and secondary intention wounds are aided by occlusive dressings and adjutants. A plethora of wound-healing adjuncts have been developed to aid wound healing in diseased states, and a working knowledge of their use is beneficial in managing all full-thickness wounds.