How to Optimize Epidermal Approximation During Wound Suturing Using a Smartphone Camera.

Precise wound approximation during cutaneous suturing is of vital importance for optimal closure and long-term scar outcomes. Utilizing smartphone camera technology as a quality-control checkpoint for objective evaluation allows the dermatologic surgeon to scrutinize the wound edges and refine their surgical technique to improve scar outcomes.

Achieving stomal continence with an ileal pouch and a percutaneous implant.

In this study, a soft-tissue-anchored, percutaneous port used as a mechanical continence-preserving valve in reservoir ileo- and urostomies was functionally and morphologically evaluated in eight dogs. During follow-up, the skin failed to attach to the implant, but the intestine inside the stoma port appeared to be attached to the mesh. After reaching adequate reservoir volume, the urostomies were rendered continent by attaching a lid to the implant. The experiments were ended at different time intervals due to implant-related adverse events. In only one case did the histological evaluation reveal integration at both the implant-intestine and implant-skin interfaces, with a low degree of inflammation and the absence of bacterial colonisation. In the remaining cases, integration was not obtained and instead mucosal downgrowth and biofilm formation were observed. The skin-implant junction was characterised by the absence of direct contact between the epidermis and the implant. Varying degrees of epidermal downgrowth, granulation tissue formation, inflammatory cell infiltration and bacterial growth and biofilm formation were prominent findings. In contrast, the subcutaneously located anchor part of the titanium port was well integrated and encapsulated by fibrous tissue. These results demonstrate the opportunity to achieve integration between a soft-tissue-anchored titanium port, skin and intestine. However, predictable long-term function could not be achieved in these animal models due to implant- and non-implant-related adverse events. Unless barriers at both the implant-skin and implant-intestine junctions are created, epidermal and mucosal downward migration and biofilm formation will jeopardise implant performance.

Dermatological surgery: an update on suture materials and techniques. Part 2.

This is the second part of a two-part series summarizing the latest evidence related to suture materials and wound closure techniques in dermatological surgery. We critically appraised evidence focusing on the following consequences of suture choice: scar/cosmesis, pain, patient satisfaction, cost, infection and wound complications. We searched the databases MEDLINE, PubMed and Embase using the keywords 'skin surgery', 'dermatological surgery', 'sutures', 'braided sutures', 'monofilament sutures' and 'antibacterial sutures' to identify relevant English-language articles. This part of the review assesses the evidence for different types of buried sutures, including braided vs. monofilament sutures, longer-absorbing sutures and antibacterial sutures. The majority of trials were noted to be of poor quality, single-centre (thus lacking external validity) and underpowered, which presents challenges in comparing suture techniques in skin surgery. Future large-scale, multicentre, randomized trials are needed, with both surgeon and patient-assessed validated outcomes.

Dermatological surgery: an update on suture materials and techniques. Part 1.

Significant variation exists in the surgical suture materials and techniques used for dermatological surgery. Many wound-closure techniques are now practised, including use of sutures, staples and topical adhesives. The focus of our review article is to summarize the latest evidence relating to suture materials and wound-closure techniques, considering the following areas: scar/cosmesis, pain, patient satisfaction, cost, infection and wound complications. We searched the databases Medline, PubMed and Embase using the keywords 'skin surgery', 'dermatologic surgery', 'sutures', 'suture techniques', 'suturing techniques' and 'surgical techniques' to identify relevant English-language articles. Absorbable superficial sutures may be a preferred alternative to nonabsorbable sutures by both patients and surgeons. Subcuticular sutures may be preferable to simple interrupted sutures for superficial wound closure, and there may also be a role for skin staples in dermatological surgery, particularly on the scalp. However, there remains limited evidence specific to dermatological surgery supporting the use of particular suture materials and suturing techniques. Further high-quality research is required, including multicentre randomized trials with larger cohorts.

#15 Versus #15c Scalpel Blades for Skin Incisions: Accuracy With and Without Magnification.

BACKGROUND: Use of a #15 blade is the most popular way for making skin incisions in dermatology. For finer and more accurate incisions, a #15c blade can be used. However, there is no evidence that demonstrates the superiority of the #15c blade over the #15 blade. OBJECTIVE: This study aimed to compare the skin incisions made with a #15 blade and #15c blade using varied magnifications. METHODS AND MATERIALS: Twenty fresh chicken thighs with intact skin were used in this study. Incisions were made on the skin using #15 and #15c blades with ×1.0, ×2.5, and ×5.0 magnification. The accuracy of the incision (length and depth) made by the different scalpel blades and magnifications was analyzed using the 2 × 3 chi-squared test. Logistic regression analysis was applied to determine factors of the incision depth and length. RESULTS: No statistically significant differences were found in the evaluations of length or depth using the 2 × 3 chi-squared test. However, the multiple logistic regression analyses showed that the incision length and depth were associated with use of the #15c scalpel blade. CONCLUSION: Use of a #15c scalpel blade with ×5.0 magnification is recommended for making incisions when less than 1- to 2-mm accuracy is required.

Ligaclip for Preauricular Skin Tags in the Newborn.

INTRODUCTION: Skin tags are benign lesions, that often represent only an aesthetic problem; if subjected to trauma, they can occasionally bleed with possible infection and pain. When they occur in the preauricular region, attention should be paid to the diagnosis and approach; in fact, controversy exists in the differential diagnosis between hair follicle nevi, accessory tragus, and skin tag. Misdiagnosis and failure of treatment can lead to serious consequences, such as chondritis. MATERIALS AND METHODS: In our retrospective study, we evaluated 19 newborns affected by single, unilateral skin tag in the preauricular region. Each patient underwent a careful clinical examination; lesions without a pilosebaceous unit and with a thin, soft pedicle were treated in the nursery with Ligaclip (Johnson & Johnson). RESULTS: Skin tag falls between day 7 and 10. We had no cases of edema, cellulitis, clip loss, or bleeding. Scarring results were extremely satisfactory at 3-month follow-up. CONCLUSION: We believe that after a careful clinical examination, cases of skin tags in the preauricular area can be selected and treated with Ligaclip. This procedure can be considered rapid, safe, economical, and simple in the newborn patients.

A Novel Absorbable Stapler Provides Patient-Reported Outcomes and Cost-Effectiveness Noninferior to Subcuticular Skin Closure: A Prospective, Single-Blind, Randomized Clinical Trial.

BACKGROUND: Deep dermal suturing is critical for scar quality outcomes. The authors evaluated a new, fast medical device for dermal suturing, with the hypothesis of noninferiority with regard to clinical scar and cost-effectiveness. METHODS: A prospective, patient-blind, randomized, multicenter noninferiority study in 26 French hospitals was conducted. Patients were randomized 1:1 to suturing with conventional thread or a semiautomatic stapler. The Patient Scar Assessment Scale was rated at 3 months for primary endpoint effectiveness. Secondary endpoints were cost-effectiveness of the two suturing methods, prevalence of complications, suturing/operating time, Observer Scar Assessment Scale and Patient Scar Assessment Scale score, scar aesthetic quality 18 months after surgery, and occupational exposure to blood during surgery. RESULTS: Six hundred sixty-four patients were enrolled, 660 were randomized, and 649 constituted the full analysis (stapler arm, n = 324; needle arm, n = 325). Primary endpoint Patient Scar Assessment Scale score in the stapler arm was not inferior to that in the needle arm at 3 months or after 18 months. The mean operating time was 180 minutes in the stapler arm and 179 minutes in the needle arm (p = not significant). The mean suturing time was significantly lower in the stapler arm (p < 0.001). There were seven occupational exposures to blood in the needle arm and one in the stapler arm. The two arms did not differ significantly in terms of complications (p = 0.41). The additional cost of using the device was &OV0556;51.57 for the complete-case population. CONCLUSION: Wound healing outcome was no worse than with conventional suturing using a semiautomatic stapler and associated with less occupational exposure to blood. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Assessment of Materials to Prevent Sutures Cutting Through Atrophic Skin.

BACKGROUND: Sutures can tear through thin skin, especially in the elderly. To reinforce thin skin, several materials have been suggested through which sutures may be placed. OBJECTIVE: To evaluate the relative tear-through resistance to suture provided by various materials applied to a skin substitute. MATERIALS/METHODS: We measured the force needed for 3-0 polypropylene suture to tear through an artificial skin substitute, both alone and after various materials were applied. These materials included wound closure tapes, nonwoven polyester tape, hydrocolloid dressing, polyethylene film, and cyanoacrylate glue. The Student t-test and one-way analysis of variance were used to determine differences in the mean forces. RESULTS: Reinforced wound closure tape and nonwoven polyester tape were superior to the other materials, and provided a 3.1-fold and 3.6-fold increase in tear-through resistance, respectively, compared with skin substitute alone (p < .001). Orientation of wound closure tape and nonwoven polyester tape with their reinforcing fibers placed parallel to the skin substitute edge provided increased tear-through resistance compared with perpendicular placement. Affixing these latter materials with liquid adhesive also improved holding strength. CONCLUSION: Reinforced wound closure tape and nonwoven polyester tape, when applied to a skin substitute, provide significantly increased tear-through resistance to suture compared with skin substitute alone.

Use of an adherent fenestrated drape to anchor an adjacent vertical sterile surgical towel.

Vertical surgical sites or those on reclining patients often present a challenge when establishing and securing a sterile field. The drape or towel most proximal to the physician is often vertically oriented. The forces of gravity and movements of surgery can shift or detach this vertical drape. Sterile clamps are not always available or are needed for securing other instruments. We present a method to secure this vulnerable drape using a central fenestrated adherent drape.

Dermatologic Laser Side Effects and Complications: Prevention and Management.

The evolution of modern laser and light-based systems has mirrored the demand for clinically effective treatments and the need for safer technologies with reduced postoperative recovery, side effects, and complications. With each new generation of lasers, more selective tissue destruction can be achieved with reduced unwanted sequelae. Patient selection and preparation, operator technique, and expeditious recognition and management of post-treatment side effects are paramount in avoiding complications and patient dissatisfaction. An overview of important variables to consider for dermatologic laser treatments are presented in order to provide a framework to reduce the severity and duration of possible post-treatment side effects and complications.

A split-face randomized controlled study comparing the efficacy and safety of intralesional radiofrequency-assisted subcision vs conventional subcision in postacne scars.

BACKGROUND: Postacne scars have significant psychosocial distress among patients. Subcision is a well-known treatment modality specially for rolling type of acne scars, but is a crude mechanical process, which carries a risk of hematoma formation. AIMS: To compare the efficacy and safety of radiofrequency-assisted subcision (rSubcision) with conventional subcision in postacne scars. METHODS: In this randomized, split-face study, adult patients with postacne scars were randomized to receive either conventional subcision or rSubcision in 2 sessions, 4 weeks apart and followed up for 2 months. Outcome was measured using Goodman and Baron score (GBS), investigator global assessment (IGA) by two blinded dermatologists, and patient global assessment (PGA). RESULTS: Seventeen out of 21 patients completed the treatment. Statistical analysis of the results was performed using SPSS 15.0 statistical software (SPSS). Patients in both the groups had significant improvement from baseline according to quantitative scoring (P = .0001), number of scars (P = .0001), IGA, and PGA. The improvement was comparable in both the groups according to GBS and IGA but better on rSubcision side in terms of PGA. Two patients developed small entry point burn during rSubcision which healed in one month and one developed persistent hematoma with conventional subcision. CONCLUSIONS: Both modalities were comparable in terms of assessment scores and investigator assessment, but patients found improvement better on rSubcision side.

Reconstrucción de un defecto de espesor total en ala nasal con malla de titanio / Reconstruction of a Full-Thickness Nasal Alar Defect With a Titanium Mesh

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