Actinic keratosis: from the skin to the lip.

PURPOSE: Actinic keratoses are commonly the result of intense sun damage to the skin and lips of susceptible patients. The purposes of this 2-section article are to familiarize the surgeon with options for care and to suggest methods of incorporation into practice as a true benefit to patients. PATIENTS AND METHODS: The first section discusses the options chosen for patients who were referred to the Facial Lesion Clinic in a county hospital for precancerous or cancerous facial lesions; the second section reviews ramifications for precancerous sun-damaged lips with clinical leukoplakia. RESULTS: Methods are available to aid patients with precancerous facial and lip lesions. Choices have been presented with patient examples. CONCLUSION: Patients with precancerous facial and lip lesions should receive therapy that diagnoses or treats these lesions. Long-term avoidance or mere observation of these lesions will portend future cancer.

Cutaneous cysts of the head and neck.

PURPOSE: This article reviews the types of cutaneous cysts in patients referred to the Facial Lesion Clinic at John Peter Smith Hospital in Fort Worth, TX, and proposes effective treatment modalities based on lesion and patient variables. Cyst variables included proper identification, size of the lesion, and acute or chronic processes. Patient considerations included age, skin type, and location. Medical and social histories were not noted. PATIENTS AND METHODS: Eighty-two patients who had 1 or more cysts removed over the 5-year period from July 15, 1998 to July 14, 2003 were reviewed for age, gender, histologic diagnosis, anatomic location of the lesion, and complications. RESULTS: Patients with epidermal inclusion cysts (79%), followed by pilar cysts (9%), hidrocystomas and dermoid cysts (3% each), and multiple other diagnoses (less than 2%) were treated. Neither complications nor recurrent infections were reported during the 5-year interval. There were no recurrent cyst formations noted by return appointment. CONCLUSION: Cystic lesions of the head and neck may be treated effectively as long as they are correctly identified and treated in a specific manner.

Reconstruction of skin cancer defects of the auricle.

PURPOSE: This article reviews the results of reconstruction of surface defects of the auricle after removal of skin cancer, and discusses the results of the delayed reconstruction method of care and modalities of treatment. PATIENTS AND METHODS: Fifty-four patients with 62 defects involving various locations on the auricle were treated. Management included direct closure, secondary epithelization, full thickness skin grafts, local flaps using direct advancement, and rotational advancement flaps using one or more stages. RESULTS: Nine defects were treated by direct closure with adjacent tissue, 12 defects healed by secondary epithelization, and 13 patients were treated with a full thickness skin graft. Twenty-eight defects were reconstructed with local flaps, which included the direct advancement, rotational flaps, transposition, and subcutaneous island flaps. No infections occurred. CONCLUSION: Many options are available for reconstruction of auricular defects which yield acceptable results. Factors to consider before choosing a reconstructive format include size, location, and depth of the defect, patient medical history, smoking, and esthetic concerns. This review exposed that patients easily accept the "delayed" method of reconstruction. Delaying allows the surgeon time to research options for care and allows the patient choices of secondary epithelization and significantly reduced costs of care.

Pivot point and secondary defect problems with rotation flaps.

PURPOSE: Our goal was to evaluate 2 design properties, pivot point and secondary defect, that affect the results of rotation flaps used to treat skin cancer defects of the head and neck. MATERIALS AND METHODS: We conducted a retrospective review of the last 50 patients who underwent rotation flaps for closure of skin cancer defects on the head and neck with regard to postoperative complications. RESULTS: Four patients experienced complications, all of which were managed to an acceptable conclusion. These complications included tip necrosis and ectropion. CONCLUSION: Rotation flaps, although simple in design, are often modified during their execution. Understanding the basic design and possible modifications of pivot point and secondary defect will yield a successful outcome.

Fibula microvascular free tissue reconstruction of the severely comminuted atrophic mandible fracture--case report.

Severely atrophic comminuted fractures of the mandible often have inadequate bone stock available to allow for adequate rigid fixation and subsequent progression to union. Grafting with rib, iliac crest or a variety of allograft materials is required in order to increase the success rate of the repair in this patient population. In this article, we report our favourable experience in using a fibula microvascular free tissue transfer for the treatment of a particularly challenging patient with a fractured atrophic mandible. Secondary implant rehabilitation completed the reconstruction. This method may represent an alternative in the treatment of fractures of the severely atrophic mandible in select individuals.