Effect of Simple Interrupted Suture Spacing on Aesthetic and Functional Outcomes of Skin Closures.

BACKGROUND: Dermatologic surgeons are trained in fundamental wound closure techniques that minimize wound tension and tissue ischemia to optimize healing and create discrete scars. These include orienting excisions along resting skin tension lines, handling tissue edges with care, and avoiding strangulation while tying suture. Another variable that may affect wound healing and cosmetic outcomes is the spacing between sutures. OBJECTIVE: This prospective, single-centre, randomized, split-scar comparison trial was designed to explore how suture spacing distance affects wound complication rate and scar cosmesis. METHODS: Elliptical surgical wounds of the trunk and extremities were repaired with simple interrupted sutures with varying suture spacing. One half of each wound was repaired with high-density suture spacing (approximately 5 mm apart) and the other with low-density suture spacing (approximately 10 mm apart). Wounds were evaluated at 2-week suture removal for complications, and then reevaluated at 3 and 6 months for cosmesis using the Patient and Observer Scar Assessment Scale score. RESULTS: Results revealed no significant difference in minor wound complications during the early healing process between high- and low-density suture spacing. At 3 months postoperatively, physicians and patients alike preferred the aesthetics of the low-density suture placement. By 6 months postoperatively, this preference disappeared. CONCLUSIONS: These results suggest that suture spacing may affect early scar formation. Additionally, placing sutures farther apart results in fewer total puncture wounds, decreases tissue trauma, and saves surgical time while conserving suture material. Therefore, dermatologic surgeons should consider placing fewer percutaneous sutures during wound repair.

In vivo stress relaxation of human scalp.

OBJECTIVE: Conduct a first in vivo study on the large deformation stress relaxation behavior of the human scalp. METHODS: This study was conducted during Mohs micrographic surgery of the scalp of 14 patients aged 59-90 with wounds initially ranging from 9 to 41 mm wide. The initial wound diameter was measured under zero applied force. Then, the force required to close each wound using a single size 1 nylon suture and a SUTUREGARD suture retention device was measured, after which the suture was then locked in the retention device at fixed displacement. At time points of 300 s, 600 s, and 1800 s, the suture retention device was released, and the wound opening was again recorded at zero force, and the force required to close the wound was recorded. RESULTS: The average wound closure force relaxed by 44% and 65% after 300 s and 1800 s, respectively. Average wound width decreased 30% and 42%, after 300 s and 1800 s, respectively, due to creep deformation. Furthermore, all wounds relaxed to be below 15 N of closure force after 600 s, which is considered the maximum clinically acceptable force. A relaxation time of ∼270 s and a threshold force for creep of ∼5 N was found. SIGNIFICANCE: Results of this study provide the first quantitative clinical guidance for efficient scalp closure of large wounds by creep deformation and stress relaxation. Furthermore, the methodology developed here can be used as a basis for future in vivo studies of the stress relaxation and creep deformation of human scalp, which in turn can provide data for the development and validation of constitutive models for scalp deformation.

Interventional treatments for Hailey-Hailey disease.

Hailey-Hailey disease or familial benign chronic pemphigus is a rare blistering dermatosis that is characterized by recurrent erythematous plaques with a predilection for the skin folds. For extensive Hailey-Hailey disease that is recalcitrant to conventional therapy, laser ablation, photodynamic therapy, electron beam radiotherapy, botulinum toxin type A, dermabrasion, glycopyrrolate, and afamelanotide have been reported as useful treatments, but comparative trials are lacking. This review discusses the various treatment modalities for Hailey-Hailey disease and a summary of the evidence for the most recommended treatments.

Generalized morphea as the first sign of breast carcinoma: a case report.

Generalized morphea is a rare idiopathic form of scleroderma that literally means "hard skin." Morphea is usually considered an isolated event that is not associated with malignancy. However, case reports of lung, hematologic, and breast cancer occurring simultaneously with large plaque morphea have caused dermatologists to question whether a work-up for malignancy is appropriate. We highlight a case of generalized morphea that preceded invasive ductal carcinoma of the breast and provide a discussion about the possible paraneoplastic origin of generalized morphea and systemic sclerosis (SSc).

Eruptive nevi associated with medications (ENAMs).

Eruptive melanocytic nevi have been reported in association with severe blistering diseases, renal transplantation, malignancy, AIDS, and medications. Eruptive nevi associated with medications have been reported with increasing frequency. Of particular interest are eruptive nevi associated with medications developing in association with biologic therapies, which we anticipate will continue to become more common as use of these medications continues to increase. We searched the databases PubMed/MEDLINE, Cochrane, and Cumulative Index to Nursing and Allied Health Literature for associated medications using the terms "eruptive nevi," "melanocytic + medications," and "nevi + medications" for relevant articles. We report the summary of our findings, which were used in defining what constitutes an eruptive nevi associated with medication and developing a classification system by medication type.

Clinical pearl: increasing utility of isopropyl alcohol for cutaneous dyschromia.

Alcohol can be used as a diagnostic aid for patients with dyschromia commonly seen in terra firma-forme dermatosis, confluent and reticulate papillomatosis, and acanthosis nigricans. Although biopsy can definitively determine diagnosis, proper utilization of isopropyl alcohol may avert unnecessary procedures.

Treatments for microcystic adnexal carcinoma--A review.

INTRODUCTION: Microcystic adnexal carcinoma (MAC) is a rare malignant cutaneous neoplasm presenting as a slow-growing, indurated nodule, papule or plaque. Clinically, the lesion can blend into the surrounding skin, obscuring borders and consequently delaying diagnosis histologically. Surgical and histologic techniques that emphasize examination of all margins may optimize management through early diagnosis and prevention of recurrences. OBJECTIVE: This review aims to assess the current surgical and histology techniques that result in lower rates of tumor recurrence and, consequently, better clinical outcomes. METHODS: A literature search of the PubMed database was conducted to identify studies examining wide local excision (WLE), Mohs micrographic surgery (MMS), radiotherapy (RT) and chemotherapy in the treatment of MAC. RESULTS: WLE had a high likelihood of positive margins and local recurrence. MMS was found to have the lowest recurrence rates. Definitive RT could be considered for elderly patients or those who are poor surgical candidates, as large surgical defects may be required to obtain free margins with either WLE or MMS. Chemotherapy was found to be ineffective. CONCLUSION: Complete margin evaluation with MMS permits complete tumor removal with subsequently low recurrence rate.