Guidelines for the use of local anesthesia in office-based dermatologic surgery.

There are an increasing number and variety of dermatologic surgical procedures performed safely in the office setting. This evidence-based guideline addresses important clinical questions that arise regarding the use and safety of local anesthesia for dermatologic office-based procedures. In addition to recommendations for dermatologists, this guideline also takes into account patient preferences while optimizing their safety and quality of care. The clinical recommendations presented here are based on the best evidence available as well as expert opinion.

Rotation Flaps-Principles and Locations.

BACKGROUND: The rotation flap is a classic method of tissue rearrangement. It is a simple yet effective tool for recruiting tissue from areas of laxity and redirecting vectors of tension to reconstruct wounds not amenable to primary closure. OBJECTIVE: This article presents the basic design principles and specific applications of the rotation flap in dermatologic surgery. METHODS: A Medline search of articles describing rotation flaps published prior to April 1, 2015 was performed, and several prominent texts in dermatologic surgery were reviewed. RESULTS: Information gathered from the above sources is combined with the clinical experience of the author and editors to present surgeons with a guide for planning and executing various rotation flaps. CONCLUSIONS: Mastering the technique of the rotation flap will allow a surgeon to repair a wide variety of cutaneous defects.

Evaluation of orbicularis oculi muscle stripping on the cosmetic outcome of upper lid blepharoplasty: a randomized, controlled study.

BACKGROUND: Many variations in the surgical treatment of upper eyelid blepharoplasty have been described, including orbicularis oculi muscle stripping. There is no evidence in the literature to support the efficacy of this technique in improving the aesthetic results of the procedure. OBJECTIVES: To conduct a single-blind, randomized, controlled, split-face pilot study to evaluate the effects of orbicularis oculi muscle stripping on upper lid blepharoplasty. METHODS: Ten subjects were randomized to receive upper lid blepharoplasty with orbicularis oculi muscle stripping on one side and skin-only blepharoplasty on the other. Patients and two blinded physicians evaluated the aesthetics of the eyelids at 1-, 3-, and 17-month follow-up visits. RESULTS: Blinded physician evaluation failed to show a difference in the overall cosmetic appearance of the eyelids between the control and treatment sides at any time point. Analysis of the composite of all patient scores showed a trend favoring the control side at 3 months (p = .28) and the treatment side at 17 months (p = .50), but neither difference was significant. CONCLUSION: Based on the data from this pilot study, orbicularis oculi muscle stripping appears to have no affect on the aesthetic outcome of upper lid blepharoplasty.

Safety precautions in Mohs micrographic surgery for patients with known blood-borne infections: a survey-based study.

PURPOSE: A survey-based study was conducted to gather expert experience on safety procedures used when performing Mohs micrographic surgery (MMS) on patients with known infectious hepatitis or human immunodeficiency virus (HIV). METHODS: Six hundred eighty-four fellowship-trained Mohs surgeons were surveyed to examine the types of safety protocols used when treating patients with known infectious hepatitis or HIV and the frequency of exposure injuries to laboratory and surgical personnel from these patients. RESULTS: One hundred eighty-eight (27.5%) surveys were collected; 64.7% of respondents reported at least one exposure injury to surgical or laboratory personnel in the past year, and 4.8% reported exposure from a patient with known hepatitis or HIV infection. Risk of reporting at least one injury from a patient with known infection within the past year was significantly less when also reporting disposal of the ink applicator after each use (relative risk [RR] = 0.109) and greater when employing laboratory personnel with no medical education or background (RR = 3.857). No exposures were reported from respondents using blunt skin hooks, safety scalpels, safety syringes, smoke evacuators, a separate ink supply, or 24-hour formalin fixation. CONCLUSION: Although firm associations cannot be made from this study, the data suggest that certain measures may help to reduce the rate of exposure injuries in MMS.

Mohs micrographic surgery for the treatment of cutaneous lymphadenoma.

Cutaneous lymphadenoma (CL) is a benign neoplasm commonly presenting on the head and neck of young and middle-aged adults. Complete surgical excision of CL is the treatment of choice and appears to be curative. As compared to local excision without margin control, Mohs micrographic surgery (MMS) may allow for more definitive tumor extirpation for large cases of CL and allow for greater tissue preservation at functionally and aesthetically sensitive sites. We present a case of cutaneous lymphadenoma presenting on the right cheek of a middle-aged male who was successfully treated with MMS.

Subcuticular incision versus naturally sourced porcine collagen filler for acne scars: a randomized split-face comparison.

BACKGROUND: Subcuticular incision is performed to release fibrotic bands beneath acne scars and to stimulate neocollagenesis. Naturally sourced porcine collagen has been approved for filling moderate to deep facial wrinkles and nasolabial folds. To our knowledge, naturally sourced porcine collagen filler has not yet been tried as a treatment for correcting atrophic acne scars. OBJECTIVE: To objectively assess and directly compare the efficacy and safety of subcuticular incision versus naturally sourced porcine collagen dermal filler in correcting atrophic and rolling acne scars. MATERIALS AND METHODS: We performed a prospective, randomized, split-face, single-blind study to evaluate intermediate long-term efficacy of subcision and collagen dermal filler on 20 unilateral faces. Patients and blinded physicians evaluated results. RESULTS: Patients rated subcision as superior to collagen dermal filler at 3 months (p=.03). At 6 months, subcision had a slightly higher rating than collagen dermal filler (p=.12). Blinded evaluators leaned toward subcision at 3 months (p=.12) and at 6 months showed no preference (p=.69). CONCLUSION: Subcuticular incision and naturally sourced porcine collagen dermal filler appear to be efficacious for improving atrophic and rolling acne scars. Patients may prefer subcuticular incision over collagen dermal filler. Blinded evaluators found no significant difference between the treatments.

Vitamin D in health and disease.

BACKGROUND/PURPOSE: Investigations have revealed that vitamin D plays an important role in many areas of health and disease. Questions over whether sun avoidance and sunscreen use will decrease vitamin D levels may concern clinicians when counseling patients at risk for vitamin D insufficiency. A review of the role of vitamin D in health and disease, the impact of photoprotection and skin type on vitamin D levels, and recommendations for adequate vitamin D intake is provided to aid clinicians in counseling patients regarding these issues. RESULTS: Review of the literature indicates that adequate vitamin D intake is associated with decreased risk of falls and bone fractures in the elderly, breast and gastrointestinal cancer risk, cardiovascular disease, and possibly all cause mortality, diabetes, and multiple sclerosis. While skin type does affect vitamin D levels, regular use of sunscreen is not associated with vitamin D insufficiency. CONCLUSIONS: Adequate intake of vitamin D is important for maintenance of good health, and may be achieved through diet and oral supplementation. Intentional or prolonged exposure to ultraviolet light should not be used as a means of obtaining vitamin D.