Fast absorbing gut sutures in dermatologic surgery: a systematic review and meta-analysis.

INTRODUCTION: Fast gut cutaneous sutures have become more prominent due to their low tissue reactivity, rapid absorption, and elimination of suture removal visits. It is not known how fast gut sutures compare to other closure modalities. METHODS: A comprehensive literature review was conducted to identify randomized controlled trials comparing fast gut sutures to alternative closure methods during dermatologic surgery. Data collected included patient and physician assessed cosmetic outcome as well as standardized complication rates. RESULTS: Six studies were included in final analysis and reported on 208 patients. Fast gut sutures were associated with lower physician opinions of final scar when compared to polypropylene sutures (SMD 0.438; 95% CI 0.082 to 0.794). No differences existed between physician opinion of fast gut sutures and cyanoacrylate tissue adhesive (SMD - 0.024; 95% CI - 0.605 to 0.556). Complications with fast gut suture placement were rare, and included infection, dehiscence, and hematomas. Fast gut sutures were less likely to experience wound dehiscence than tissue adhesive (p = 0.01). CONCLUSION: If no contraindications to polypropylene sutures exist, they may provide superior cosmetic outcomes compared to fast gut sutures. Further research is required to better quantify cosmetic outcomes and optimal use of fast gut sutures.

Nasal tip rotation flap for reconstruction of surgical defects on the distal nose.

BACKGROUND: The nose is a common site for the development of skin cancers. Mohs micrographic surgery (MMS) is a highly curative treatment for skin cancer of the nose. Reconstruction of MMS defects on the nose, especially on the distal aspect, can be challenging given the proximity of multiple subunits and limited adjacent tissue reservoirs. Our goal was to describe our experience using a nasal tip rotation flap (NTRF) for MMS defects on the distal nose. METHODS: A retrospective review of all MMS cases at multiple institutions between June 2018 and June 2022 was undertaken. Cases that used an NTRF to repair the MMS defect(s) were selected, and data were collected on patient demographics, tumor type, anatomical location of the tumor, preoperative and postoperative size, number of stages needed to clear the tumor, repair dimensions, and any postoperative complications. RESULTS: A total of 66 cases that utilized an NTRF for reconstruction were included. The mean preoperative tumor size was 0.8 cm (range: 0.3-1.6 cm), and the mean defect size was 1.2 cm (range: 0.7-1.9 cm). The defects were most commonly on the nasal tip. There were no significant complications observed. CONCLUSIONS: The nasal tip rotation flap is a reliable reconstruction option for MMS defects of the distal nose. This flap can be used for defects that involve the nasal tip, soft triangle, and/or portions of the ala, including the alar rim.

Intraneural Melanoma Identified With MART-1 Immunostaining in Mohs Micrographic Surgery.

Mohs micrographic surgery (MMS) utilizing melanoma antigen recognized by T-cells (MART-1) immunostaining is an increasingly common method of treatment for minimally invasive melanoma in anatomically constrained areas such as the face, ears, or acral sites. Neurotropic melanoma, also known as neurotrophism in melanoma, refers to the invasion of melanoma cells into the nerves. As such, these tumors can extend well beyond anticipated clinical tumor margins which can increase the risk of local recurrence. Here, we present a case of neurotropic melanoma successfully identified during MMS using MART-1 immunostaining, which was then confirmed with permanent sectioning.

The Two-Stage Folded Paramedian Forehead Flap Without Cartilage Grafts for Full Thickness Distal Nasal Defects: A Review of 35 Patients.

BACKGROUND: Full thickness defects of the ala, soft triangle, and nasal tip involving the nasal lining have traditionally been repaired with the three-stage folded paramedian forehead flap (FPFF), with a cartilage graft for support. For similar defects, the authors utilize the two-stage FPFF without cartilaginous support which provides reproducible functional and aesthetic results.  Objective: To describe the authors’ experience with the two-stage FPFF, including outcomes, complications, and design modifications to enhance functional and aesthetic success.  Methods: An IRB-approved retrospective database review of FPFF was performed at two sites. Using postoperative photographs, outcomes were assessed by blinded non-investigator dermatologist raters using a modified observer scar assessment scale. RESULTS: Thirty-five patients were reconstructed using the two-stage FPFF without cartilage grafts. Subjective assessment of scar vascularity, pigment, relief, and thickness by 3 independent reviewers yielded an overall cosmesis score of 8.4±1.9 (out of 40). CONCLUSION: The two-stage FPFF without cartilage grafts is a reliable, cosmetically elegant repair that can provide optimal functional and aesthetic results for complex unilateral distal nose defects.J Drugs Dermatol. 2024;23(4): doi:10.36849/JDD.7358.

Cadaveric Split-Thickness Skin Graft With Partial Guiding Closure for Scalp Defects Extending to the Periosteum.

A scalp defect that extends to or below the periosteum often poses a reconstructive conundrum. Achieving the level of tissue granulation necessary for secondary-intention healing is challenging without an intact periosteum; surgeons often resort to complex rotational flap closures in this scenario. For tumors at high risk for recurrence and in cases in which adjuvant therapy is necessary, tissue distortion with a complex rotational flap can make monitoring for recurrence difficult. Similarly, for elderly patients with substantial skin atrophy or those in poor health, extensive closure may be undesirable or more technically challenging and poses a higher risk for adverse events. Additional strategies are necessary to optimize wound healing and cosmesis. Granulation and epithelialization of wounds can be expedited using a cadaveric split-thickness skin graft (STSG) of biologically active tissue. We describe this technique and show its utility in cases in which there is concern for delayed or absent tissue granulation, or when monitoring for recurrence is essential.

Double V-Y Island Pedicle Flap for Dorsal Hand Reconstruction Following Mohs Micrographic Surgery.

Medium to large defects on the dorsal hand pose a reconstructive challenge following dermatologic surgery. Repairs in this location can be complicated by a paucity of adjacent tissue reservoirs, competing tension vectors, thin cutaneous tissue, and superficial tendons and vasculature. In such cases, a double V-Y island pedicle flap is an effective reconstructive solution. It preserves hand function, harnesses local tissue with a robust blood supply, facilitates complete closure, and provides skin that closely matches the original's color and texture. Here, we present the repair of a medium to large dorsal hand defect after Mohs micrographic surgery for melanoma in situ, using a double V-Y island pedicle flap.

Treatment of Angiosarcoma of the Head and Neck: A Systematic Review.

Primary cutaneous angiosarcoma (cAS) of the head and neck is a rare sarcoma with a poor prognosis and limited treatment options. We conducted a systematic review of treatments used for head and neck cAS and determined the treatment modalities that offer the longest mean overall survival (OS). Forty publications totaling 1295 patients were included. Both surgical and nonsurgical modalities have shown potential efficacy in the treatment of cAS; however, limited data preclude definitive recommendations. Multidisciplinary management of cAS should be considered to tailor treatment on a case-by-case basis.

Factors Influencing General Dermatologists When Referring Patients With Head and Neck Melanoma for Mohs Micrographic Surgery: A Nationwide Cross-Sectional Survey.

BACKGROUND: Mohs micrographic surgery (MMS) for cutaneous melanoma has demonstrated higher cure rates, lower local recurrence rates, and improved survival compared with wide local excision (WLE). However, factors affecting referrals by general dermatologists for MMS of head and neck melanoma (HNM) are unknown. OBJECTIVE: To elucidate referral factors and treatment perspectives of general dermatologists regarding MMS for melanoma in situ (MIS)/lentigo maligna (LM) and early-stage melanoma on the head and neck. MATERIALS AND METHODS: A cross-sectional analysis was performed using survey responses of general dermatologists with membership in the American Academy of Dermatology . RESULTS: A total of 231 and 132 of the 402 responding general dermatologists routinely referred melanoma in situ MIS/LM and early invasive melanoma for MMS, respectively. Lack of local access to a Mohs surgeon was the most common deterring reason for MIS/LM referral to MMS, whereas the preference for WLE was the most common deterring reason for early invasive melanoma. CONCLUSION: Lack of local access to a Mohs surgeon treating HNM with MMS is the primary barrier in referrals to Mohs surgeons for MIS and LM. Among general dermatologists, WLE is preferred for early invasive HNM.