Evidence-based clinical practice guideline: Reconstruction after skin cancer resection.

A multi-disciplinary work group involving stakeholders from various backgrounds and societies was convened to develop guidelines for the management of reconstruction after skin cancer resection. The goal was to identify areas of common ground and provide evidence-based recommendations to improve patient care. Given the heterogeneity of reconstructive techniques and clinical scenarios, investigation centered around common elements in the process. In some cases, a distinction was made between treatment options in the office-based setting as opposed to those in the facility setting. A systematic literature review was performed, and an established appraisal process was used to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development, and Evaluation methodology). Final recommendations are related to concepts concerning the timing of reconstruction, management of anticoagulation, use of antibiotics, methods of pain control, and follow-up assessment. At times, there was insufficient evidence to make high-level recommendations. The literature analysis highlights the need for additional methodologically robust studies in this area, to help guide clinical practice.

Evidence-Based Clinical Practice Guideline: Reconstruction after Skin Cancer Resection.

SUMMARY: A multi-disciplinary work group involving stakeholders from various backgrounds and societies was convened to develop guidelines for the management of reconstruction after skin cancer resection. The goal was to identify areas of common ground and provide evidence-based recommendations to improve patient care. Given the heterogeneity of reconstructive techniques and clinical scenarios, investigation centered around common elements in the process. In some cases, a distinction was made between treatment options in the office-based setting as opposed to those in the facility setting. A systematic literature review was performed, and an established appraisal process was used to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development, and Evaluation methodology). Final recommendations are related to concepts concerning the timing of reconstruction, management of anticoagulation, use of antibiotics, methods of pain control, and follow-up assessment. At times, there was insufficient evidence to make high-level recommendations. The literature analysis highlights the need for additional methodologically robust studies in this area, to help guide clinical practice.

A Single Surgeon's Experience With Transgender Female-to-Male Chest Surgery.

BACKGROUND: Chest wall recontouring is a common surgical treatment of gender dysphoria in transmen and nonbinary individuals assigned female at birth. This study reviews more than 20 years of cases to identify risk factors for postoperative complications and likelihood of preservation of nipple sensation. METHODS: One hundred thirty-seven cases of female-to-male chest wall recontouring by a single surgeon from 1994 to 2016 were reviewed, 99 of which were included for final analysis. Double-incision free nipple graft and double incision with nipple transposition on a pedicle were the most common techniques used. Complication rates between these 2 techniques were compared, and multivariate analysis was used to identify possible predictors of major complications, and minor complications. RESULTS: No significant risk factors for major complications were identified. With regard to minor complications, advanced patient age (odds ratio [OR], 1.67; P = 0.03) and early surgical experience (OR, 5.08; P = 0.001) were found to be associated with increased risk. Preoperative hormonal treatment was found to trend toward a protective effect (OR, 0.13; P = 0.07). CONCLUSIONS: Any of the reviewed techniques are safe in practice; however, there is a learning curve associated with their use, and longer follow-up will allow for the identification of late complications. The double incision with nipple transposition on a pedicle technique can be considered for patients for whom depigmentation of the nipple-areola complex is a significant concern, especially if they are willing to tolerate a potentially suboptimal chest contour.

Evidence-Based Clinical Practice Guideline: Reconstruction after Skin Cancer Resection.

SUMMARY: A multi-disciplinary work group involving stakeholders from various backgrounds and societies was convened to develop guidelines for the management of reconstruction after skin cancer resection. The goal was to identify areas of common ground and provide evidence-based recommendations to improve patient care. Given the heterogeneity of reconstructive techniques and clinical scenarios, investigation centered around common elements in the process. In some cases, a distinction was made between treatment options in the office-based setting as opposed to those in the facility setting. A systematic literature review was performed, and an established appraisal process was used to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development, and Evaluation methodology). Final recommendations are related to concepts concerning the timing of reconstruction, management of anticoagulation, use of antibiotics, methods of pain control, and follow-up assessment. At times, there was insufficient evidence to make high-level recommendations. The literature analysis highlights the need for additional methodologically robust studies in this area, to help guide clinical practice.

A primary protocol for the management of ear keloids: results of excision combined with intraoperative and postoperative steroid injections.

BACKGROUND: Keloids of the ear are a challenging problem, with many treatment modalities advocated. The primary determinant in choosing a treatment protocol should be a low recurrence rate. Most reports in the literature suffer from small numbers of patients and inadequate follow-up. METHODS: This study presents a retrospective analysis of 64 patients representing 92 ear keloids treated between 1982 and 1997. The treatment protocol consisted of excision with an intraoperative and two postoperative steroid injections. All patients were treated by a single physician. Long-term follow-up was obtained at a minimum of 5 years. RESULTS: Protocol success was achieved in 74 of 92 keloids (80 percent) excised. Prior excision of the keloid was significantly associated with protocol failure (p = 0.0068). Keloid recurrence was seen in 10 of 43 (23 percent). Statistically significant differences were noted in keloids that had undergone prior excision as compared with those presenting for initial treatment. These differences included growth rate (p = 0.0026), protocol failure (p = 0.0149), and total postoperative steroid injections administered (p = 0.0104). CONCLUSIONS: The primary protocol presented for the treatment of ear keloids produces durable results, with an acceptably low recurrence rate. Stratification of keloids based on an assessment of aggressiveness may allow for a more informed choice in their optimal treatment.