Reconstruction of surgical defect of the dorsum of the hand.

In some cases, keratoacanthomas can be indistinguishable from squamous cell carcinoma, making the gold standard treatment surgical excision with histopathological evaluation. The surgical defects created on the back of the hand can be challenging to repair. We describe the use of bilateral rotation flap as an option in this area, and discuss the indications and contraindications of some of the possible surgical techniques for reconstruction of the dorsum of the hand.

Pulsed Dye Laser Therapy in the Treatment of Warts: A Review of the Literature.

BACKGROUND: Warts or verrucae vulgaris are common cutaneous infections with currently no definitive curative treatments available. OBJECTIVE: To determine the efficacy of pulsed dye laser (PDL) in the treatment of warts. MATERIALS AND METHODS: A literature search was performed using the PubMed and MEDLINE databases. A search using {(Wart[s], verruca or condylomata)} AND [(Pulsed dye laser)] was used. Forty-four articles were identified as relevant to this review. RESULTS: Simple warts were very responsive to PDL, being treated successfully in over 95% of patients. Facial and anogenital warts also demonstrated excellent outcomes. Recalcitrant warts, displayed significant variability in their response, ranging between 50% and 100% across all articles. The response rates seen in peripheral warts (involving the hands and feet) were also very variable, ranging between 48% and 95%. Recurrence rates at 4 months of follow-up were documented as 0% to 15%. Complications have been described as very few and rare, the main ones being topical discomfort and erythema. CONCLUSION: Pulsed dye laser is a safe and effective modality in the treatment of warts that can be applied to most body parts. Cost and availability remain a limitation to the use of PDL; however, this modality can be used when other more traditional and accessible treatments have failed.

Reconstruction of surgical defect of the dorsum of the hand

Abstract In some cases, keratoacanthomas can be indistinguishable from squamous cell carcinoma, making the gold standard treatment surgical excision with histopathological evaluation. The surgical defects created on the back of the hand can be challenging to repair. We describe the use of bilateral rotation flap as an option in this area, and discuss the indications and contraindications of some of the possible surgical techniques for reconstruction of the dorsum of the hand.

Novel Treatment Approach for Deep Palmoplantar Warts Using Long-Pulsed 1064-nm Nd:YAG Laser and a Moisturizing Cream Without Prior Paring of the Wart Surface.

OBJECTIVE: The present study aimed to assess the safety and efficacy of palmoplantar wart removal using long-pulsed 1064-nm Nd:YAG laser after application of a moisturizing cream. BACKGROUND: Previously described laser treatments for wart removal are associated with negative side effects and need to pare the warts before laser treatment. PATIENTS/METHODS: Two hundred forty patients (142 males, 98 females) were treated for 1-40 palmoplantar warts by long-pulsed 1064-nm Nd:YAG laser (spot size 4-6 mm, pulse duration 20 msec, fluence 200 J/cm2) after covering the wart surface with a thin film of a moisturizing cream. The endpoint was lesion graying or whitening with or without development of a hemorrhagic bulla beneath the treated wart. Color photographs were taken before and immediately after each laser session and at 1, 4, and 16 weeks after the last session. RESULTS: The overall clearance rate was 97%, with 90% of treated patients cured after one session, 4% after two, and 3% after three. Clearance rate after three laser sessions decreased linearly with the number of warts from 100% to 95%. Less accessible wart location in interdigital spaces also decreased the cure rate after three sessions from 100% to 95%. Additionally, warts became more difficult to eradicate as they aged. Remission lasted up to 6 years, and complications were mild and infrequent (17.5%). CONCLUSIONS: This novel method is effective in removing palmoplantar warts. It is easier, time-saving, and safer than other methods described in previous studies conducted with ablative or nonablative lasers.

Evaluation of Nd:YAG laser device efficacy on onychomycosis: a case series of 30 patients.

Until recently, pharmacologic molecules have been the only available treatments for onychomycosis. Laser treatments were introduced for recurrent or resistant cases or in patients in whom oral treatments are contra-indicated. Some devices were approved by the Food and Drug Administration (FDA). Neodymium yttrium aluminium garnet (Nd:YAG) is used for onychomycosis as a short-pulse or a long-pulse system. We aim to evaluate the efficacy of the short-pulse Nd:YAG in treating onychomycosis, its side effects, cure rates, and 12-month recurrence rates. Efficacy was evaluated based on a subjective measure of patient satisfaction on a scale from 1 to 10, and an objective measure based on the results of the mycologic cultures. Medical records of 30 patients were reviewed. Ages ranged from 22 to 85, with a mean of 44. Mycologic cure at 12 months was not achieved in 5 patients (16.67%) who had received laser treatment. None of these patients showed any signs of clinical improvement. Twenty patients (66.67%) were completely cured at 12 months, with corroborating negative mycologic cultures. The remaining five patients (16.67%) had discordance between their clinical cure status and their mycologic cultures. Side effects were reported by 7 patients out of 30 (33%): pain within 48 hours of the treatment session, burning sensation in the treated nail bed area. Our primary end point of negative mycologic cultures at 12 months was seen in 24 out of 30 (80%) of our patients. Similar culture cure rates have not been reported before, not even with systemic treatments with oral antifungals. However, few limitations should warrant us (False-negative results in fungal cultures; time limitation; sample size…). Still, we propose that this alternative should be offered for patients in whom antifungals are contraindicated or for patients previously treated, but not cured by oral antifungals, and in elderly and polymedicated patients.

The Overlapped Triple Circle Pulse Technique with Nd:YAG Laser for Refractory Hand Warts.

BACKGROUND AND OBJECTIVE: Inadvertent superficial treatment of hand warts causes recurrence, whereas aggressive treatment can lead to tissue defects resulting in hand dysfunction. This study aimed to determine the effectiveness of a novel laser treatment modality for recalcitrant hand warts. MATERIALS AND METHODS: The study included 51 patients who were treated for 146 recalcitrant hand warts using 1064 nm long-pulsed Nd:YAG laser between 2011 and 2014. The laser treatment method is novel because each treated wart was aligned at the intersection point of the circles of 3 laser pulses per session. RESULTS: Among the 146 hand warts, 88.35% were successfully treated with one session and 100% of those that required a second treatment session were treated successfully, based on the 12 month follow-up examination. CONCLUSIONS: Long-pulsed Nd:YAG laser treatment was observed to be a safe, rapid, and effective method for treating recalcitrant hand warts.

Single-Port Endoscopic Thoracic Sympathectomy with Monitored Anesthesia Care: A More Promising Procedure for Palmar Hyperhidrosis.

OBJECTIVES: Thoracic sympathectomy is considered the most effective method to treat palmar hyperhidrosis. We presented a novel procedure for thoracic sympathectomy treating palmar hyperhidrosis which could be performed under monitored anesthesia care. The aim of this study was to evaluate the continuing efficacy and safety of this innovative surgery. METHOD: From May 2011 to May 2014, we performed the single-port endoscopic thoracic sympathectomy (ETS) with a flexible thoracoscopy in 32 patients under monitored anesthesia care. All patients were followed up until today. RESULTS: Under monitored anesthesia, all patients were awake during the procedure. A proper sedation and local anesthesia make it possible for patients to communicate with surgeons. The symptoms disappeared immediately when the sympathectomy was done. No surgical complications occurred during the procedure. All patients were discharged from the hospital on the first morning of postoperative day. Compared with the traditional approach, the advantages of less operative costs, fewer hospital days, and better recovery were suggested. CONCLUSIONS: Single-port ETS with flexible thoracoscopy under monitored anesthesia is a promising procedure for palmar hyperhidrosis.