ABSTRACT
BACKGROUND: The V-Y island advancement flap is a useful reconstruction technique for nasal alar defects, but flap mobility is limited by the insertion of the muscles of facial expression into the dermis of the alae. OBJECTIVE: To describe a V-Y muscle sling myocutaneous island advancement flap (SMIAF) for improved mobility and intrasubunit reconstruction of alar defects. MATERIALS AND METHODS: A retrospective review of patient records and preoperative and postoperative photographs was performed on all patients with alar defects repaired with the SMIAF between April 2008 and October 2017. Patients and physicians rated aesthetic outcomes with the Patient and Observer Scar Assessment Scale (POSAS). RESULTS: A total of 18 nasal alar defects were repaired with the SMIAF after Mohs micrographic surgery. All defects were located on the anterior two-thirds of the alar lobule and had a mean surface area of 0.42 ± 0.19 cm. No patients experienced flap necrosis. Patients and 3 independent dermatologic surgeons rated favorable aesthetic outcomes. CONCLUSION: The SMIAF is a reliable reconstruction option with good aesthetic outcomes for small defects on the anterior two-thirds of the nasal ala.
Subject(s)
Cicatrix/prevention & control , Mohs Surgery/adverse effects , Myocutaneous Flap/transplantation , Nose Neoplasms/surgery , Rhinoplasty/methods , Skin Neoplasms/surgery , Adult , Aged , Cicatrix/diagnosis , Cicatrix/etiology , Esthetics , Female , Humans , Male , Middle Aged , Myocutaneous Flap/pathology , Necrosis/epidemiology , Necrosis/etiology , Nose/anatomy & histology , Nose/pathology , Nose/surgery , Patient Reported Outcome Measures , Reproducibility of Results , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: There is limited data regarding generic medication prices. Recent studies have shown price changes at the retail level, but much is not known about the pharmaceutical supply chain or price changes at the manufacturer level. OBJECTIVE: We sought to examine the extent of price changes for topical generic medications. METHODS: A comprehensive review of average wholesale prices (AWPs) and manufacturers of topical generics and available corresponding branded medications was conducted for 2005 and 2016. RESULTS: A total of 51 topical chemical entities were examined. Between 2005 and 2016, the AWP of topical generic medications increased by 273% and the AWP of topical branded medications increased by 379%. The topical generic with the greatest price change increased by 2529%. Eight of the top 20 topical generic medications with the greatest increases in AWP also had an increase in the number of manufacturers. LIMITATIONS: These findings are not generalizable to medications used in other areas of medicine. CONCLUSION: Topical generic prices are rapidly increasing at the manufacturer level.
Subject(s)
Commerce/trends , Dermatologic Agents/economics , Drug Costs/trends , Drug Industry/trends , Drugs, Generic/economics , Administration, Topical , Costs and Cost Analysis , Dermatologic Agents/administration & dosageSubject(s)
Melanoma/diagnosis , Melanoma/surgery , Skin Neoplasms/diagnosis , Skin Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Eosine Yellowish-(YS) , Female , Fluorescent Dyes , Frozen Sections , Hematoxylin , Humans , MART-1 Antigen/analysis , Male , Margins of Excision , Melanoma/chemistry , Middle Aged , Mohs Surgery , Prospective Studies , Sensitivity and Specificity , Skin Neoplasms/chemistry , Tissue FixationABSTRACT
Cutaneous sarcomas are rare malignancies that may present with a variety of clinical manifestations. This article focuses on 4 of the most common cutaneous sarcomas (Kaposi sarcoma, cutaneous angiosarcoma, dermatofibrosarcoma protuberans, and cutaneous leiomyosarcoma) and reviews clinical, diagnostic, and therapeutic aspects of these rare skin malignancies.