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1.
Pan Afr Med J ; 33: 297, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692830

RESUMO

Usually most patients with dermatofibrosarcoma protuberans (DFSP) may present rather late when the tumor is in protuberant phase due to its rarity and indolent onset. It has a high propensity for local recurrence and destructive nature. Management of DFSP requires a biopsychosocial and Multidisplinary approach regardless of the clinical or immunohistochemical variant. Surgery is the Gold standard management of localized disease. DFSP rarely exhibits any lymphatic or hematogenous dissemination. It is because of its high recurrence rate associated with Wide Local Excision (WLE), the introduction of Mohs micrographic surgery (MMS) has really helped in reducing the rates of recurrence of DFSP. Thus, the aim of this meta-analysis and systemic review is to advocate for MMS over WLE for DFSP and other cutaneous malignancies using DFSP as a prototype. The objective of this study were to conduct a meta-analysis on comparative surgical methods used in the cure of DFSP with regards to WLE verses MMS, to evaluate the cure rates with relation to recurrence rates, offer a recommendation on the various treatment modalities based on the location of lesion, and use of adjuvant therapy in different clinical-medical setups. A comprehensive retrospective analysis search in EMBASE, Google Scholar and Medline (PubMed) for studies published from 2008 to 2018 containing the surgical management of DFSP with WLE verses MMS were reviewed. Five studies of moderate-quality evidence (level B) with a pooled patient load of 684 was analyzed and found for recurrence of DFSP after WLE and MMS to be 9.10% and 2.72% respectively after an average follow-up time for both groups of 5.32 years with a female predominance of 1.58. The trunk is the commonest site for the DFSP lesion which was at 52.80% then the upper and lower extremities zones and the head and neck zones at 31.75% and 15.45% respectively. The pooled adjusted odds ratio (OR) analysis indicated that there was a direct relationship with regards the reduced recurrence rate of DFSP in the MMS group compared to the WLE group (OR:0.31;95%; CI :0.17-0.56). Furthermore, there was significant association between the reduced recurrence rate with the MMS in DFSP patients with a statistical P-value of 0.0001 at 95% CI. The expected increased recurrence rate by zones was in WLE head and neck zone at 38.19% then trunk and extremities zone at 13.34%. In the MMS group it was at of 23.4% as compared to 16.0% in the head and neck zone. Mohs Micrographic Surgery (MMS) is more efficacious in the cure rate and recurrence reduction of DFSP and should be advocated for as first line therapy especially in high recurrence prone zones.


Assuntos
Dermatofibrossarcoma/cirurgia , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Dermatofibrossarcoma/patologia , Procedimentos Cirúrgicos Dermatológicos/métodos , Humanos , Recidiva Local de Neoplasia , Neoplasias Cutâneas/fisiopatologia , Resultado do Tratamento
2.
Am Surg ; 85(10): 1139-1141, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657310

RESUMO

Decisions regarding whether to close the skin in trauma patients with hollow viscus injuries (HVIs) are based on surgeon discretion and the perceived risk for an SSI. We hypothesized that leaving the skin open would result in fewer wound complications in patients with HVIs. We performed a retrospective analysis of all adult patients who underwent operative repair of an HVI. The main outcome measure was superficial or deep SSIs. Of 141 patients, 38 (27%) had HVIs. Twenty-six patients developed SSIs, of which 13 (50%) were superficial or deep SSIs. On adjusted analysis, only female gender (P = 0.03) and base deficit were associated (P = 0.001) with wound infections Open wound management was not associated with a decreased incidence of SSIs (P = 0.19) in patients with HVIs. Further research is required to determine optimal strategies for reducing wound complications in patients sustaining HVIs.


Assuntos
Traumatismos Abdominais/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais/efeitos adversos , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Ferida Cirúrgica/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais/estatística & dados numéricos , Adulto , Antibioticoprofilaxia/estatística & dados numéricos , Procedimentos Cirúrgicos Dermatológicos/métodos , Duodeno/lesões , Feminino , Humanos , Intestino Delgado/lesões , Jejuno/lesões , Masculino , Estudos Retrospectivos , Pele , Estatísticas não Paramétricas , Estômago/lesões , Infecção da Ferida Cirúrgica/classificação , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle
3.
Hautarzt ; 70(11): 850-853, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31560079

RESUMO

Current guidelines generally recommend continuation of blood thinning drugs in dermatologic surgery and the previously used "bridging" with subcutaneous or intravenous heparin is obsolete. While the guidelines are increasingly implemented in daily practice, there is still uncertainty concerning the use of the novel direct oral anticoagulants (NOAC = DOAC). In this review, we analyze current developments and formulate concise recommendations for continuation during skin surgery under consideration of individual risk.


Assuntos
Anticoagulantes/administração & dosagem , Dabigatrana/administração & dosagem , Procedimentos Cirúrgicos Dermatológicos/métodos , Hemorragia Pós-Operatória/induzido quimicamente , Guias de Prática Clínica como Assunto , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Rivaroxabana/administração & dosagem , Administração Oral , Anticoagulantes/uso terapêutico , Humanos , Hemorragia Pós-Operatória/terapia , Medição de Risco
4.
Rev. bras. cir. plást ; 34(3): 419-422, jul.-sep. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047172

RESUMO

Procedimentos de rejuvenescimento facial substitutos da cirurgia tradicional tornaram-se cada vez mais populares para promover uma aparência jovial com procedimentos minimamente invasivos, como toxina botulínica injetável, preenchimento de tecidos moles e peelings químicos. No entanto, complicações podem ocorrer mesmo na presença de um injetor habilidoso e experiente. Apresentamos o caso de uma paciente submetida a reanimação labial estática usando retalho dermoadiposo para lesão do nervo facial direito após remoção de nódulos como complicação de preenchimento. A "abordagem modificada de bull horn" foi realizada para elevação do lábio superior em torno das asas nasais e columela e ao longo do sulco nasolabial direito. O retalho foi desepitelizado e obtido. Usando a ponta aberta de uma pequena cânula de lipoaspiração, a porção distal do retalho foi encapsulada e fixada diretamente em C-loop e foram utilizados pontos U, transfixando o retalho para o periósteo do arco zigomático. Nos três anos de seguimento não foram observadas complicações significativas e a paciente não relatou nenhuma limitação funcional ou insatisfação com o aspecto das cicatrizes no sulco nasolabial e ao redor das asas nasais e da columela.


Facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular to promote a youthful appearance with minimally invasive procedures such as injectable botulinum toxin, soft-tissue fillers, and chemical peels. Nevertheless, complications can occur even with an astute and experienced injector. Here we present the case of a patient who underwent static lip reanimation using a dermoadiposal flap for right facial nerve damage following nodule removal as a filler complication. A "modified bulls horn approach" to the upper lip lift was performed around the nasal wings and columella and along the right nasolabial fold. The flap was de-epithelized and harvested. Using the open tip of a small liposuction cannula, the distal portion of the flap was tunneled and fixed directly in a C-loop fashion using U stitches, transfixing the flap to the periosteum of the zygomatic arch. At 3 years follow-up, no significant complications were observed, and the patient reported no functional limitations or dissatisfaction with the scars in the nasolabial fold or around the nasal wings and columella.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , História do Século XXI , Rejuvenescimento , Cirurgia Plástica , Toxinas Botulínicas , Procedimentos Cirúrgicos Reconstrutivos , Face , Traumatismos Faciais , Paralisia Facial , Procedimentos Cirúrgicos Dermatológicos , Preenchedores Dérmicos , Lábio , Cirurgia Plástica/efeitos adversos , Cirurgia Plástica/métodos , Toxinas Botulínicas/análise , Toxinas Botulínicas/efeitos adversos , Toxinas Botulínicas/uso terapêutico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/reabilitação , Face/cirurgia , Traumatismos Faciais/cirurgia , Traumatismos Faciais/complicações , Traumatismos Faciais/reabilitação , Paralisia Facial/cirurgia , Paralisia Facial/complicações , Procedimentos Cirúrgicos Dermatológicos/métodos , Preenchedores Dérmicos/análise , Preenchedores Dérmicos/efeitos adversos , Lábio/anormalidades , Lábio/cirurgia
5.
Rev. bras. cir. plást ; 34(3): 391-398, jul.-sep. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047162

RESUMO

Introdução: Queloides surgem de resposta excessiva à lesão da derme, resultando em proliferação de fibroblastos, produção exagerada de colágeno e comprometimento da pele sadia adjacente. O diagnóstico é clínico e muitos métodos conservadores e cirúrgicos já foram utilizados para tratamento. Porém, dados da eficácia desses tratamentos são limitados e não há consenso na literatura quanto a melhor técnica a ser empregada, permanecendo uma lacuna que necessita ser preenchida, a fim de que seus usos sejam indicados com maior confiabilidade, em um modelo de medicina baseada em evidências. Métodos: Revisão não sistemática da literatura sobre "queloides" nas bases de dados PubMed, Scielo, MEDLINE, UptoDate e livros-texto das áreas de Dermatologia e Cirurgia Dermatológica. Revisão de Literatura: Foram enumeradas e abordadas as principais informações sobre técnicas cirúrgicas e adjuvantes empregadas para essas lesões, que são: excisão, injeções intralesionais, crioterapia, laserterapia, revestimento com gel de silicone, radioterapia e pressoterapia. Torna-se relevante o levantamento dessas informações, tendo em vista que, além de poder causar dor, prurido e restrição de movimento, o principal motivo da procura de assistência médica para queloide é devido ao aspecto cosmético/estético, e as taxas de reincidência e falha terapêutica ainda são altas, sendo necessário conscientizar o paciente sobre o procedimento e seus efeitos. Conclusão: São muitos os tratamentos disponíveis para o queloide, sejam cirúrgicos ou não, todavia não há consenso sobre uma abordagem universalmente aceita. São necessários mais estudos, com a finalidade de definir a melhor conduta e atingir melhores resultados, visto a qualidade mediana das evidências apresentadas nos estudos.


Introduction: Keloids are characterized by an abnormal response to dermal trauma, resulting in fibroblast proliferation, excessive collagen production, and impairment of adjacent healthy tissue. The diagnosis is clinical, and many conservative and surgical methods can be used as treatments. However, data on the efficacy of these treatments are limited, and there is no consensus regarding the best treatment option. This gap needs to be filled by developing comprehensive evidence-based therapies. Methods: A non-systematic literature review of keloid scars was carried out using PubMed, Scielo, MEDLINE, UptoDate, and dermatology and dermatological surgery textbooks. Literature review: The search retrieved relevant information on surgical and adjuvant therapies used for keloids, including excision, intralesional injections, cryotherapy, laser therapy, silicone gel sheeting, radiation therapy, and pressure therapy. These data are crucial because, in addition to complaints of pain, itching, and restriction of movement, the main reason for seeking treatment for keloids is for cosmetic and aesthetic improvement, and the rates of recurrence and treatment failure are high, emphasizing the importance of creating awareness regarding the available procedures and their effectiveness. Conclusion: Many surgical and adjuvant therapies for keloids are available. Nonetheless, there is no consensus on a universally accepted treatment. Therefore, additional high-quality studies are needed to identify the most effective therapeutic approaches to achieve better results.


Assuntos
Humanos , História do Século XXI , Recidiva , Cirurgia Plástica , Terapêutica , Fator 1 de Crescimento de Fibroblastos , Fibroblastos , Procedimentos Cirúrgicos Dermatológicos , Queloide , Cirurgia Plástica/efeitos adversos , Cirurgia Plástica/métodos , Terapêutica/métodos , Ferimentos e Lesões , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/terapia , Fator 1 de Crescimento de Fibroblastos/análise , Fator 1 de Crescimento de Fibroblastos/efeitos adversos , Cicatriz , Cicatriz/complicações , Procedimentos Cirúrgicos Dermatológicos/métodos , Queloide/cirurgia
7.
Ann Hematol ; 98(8): 1867-1875, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30993415

RESUMO

Refractory skin ulcers due to severe chronic graft-versus-host disease (cGVHD) remain to be associated with significant morbidity and mortality.We performed an allogeneic donor skin transplantation in seven adult patients after allogeneic hematopoietic stem cell transplantation for cGVHD-associated refractory skin ulcers. While four patients received a split skin graft (SSG), in one patient, a full thickness skin graft for two small refractory ulcers of the ankle was performed, and one patient received in vitro expanded donor keratinocyte grafts derived from hair roots of the original unrelated donor. In one additional patient, a large deep fascial defect of the lower leg was covered with an autologous greater omentum free graft before coverage with an allogeneic SSG. An additional patient was treated with an autologous scrotal skin graft for a refractory ulcer associated with deep sclerosis of cGVHD after unrelated donor transplantation.All skin grafts engrafted and resulted in permanent coverage of the grafted ulcers without any signs of immunological mediated damage. In the patient receiving in vitro expanded keratinocyte grafts, two localized ulcers were permanently covered by donor skin while this approach failed to cover extensive circular ulcers of the lower legs.Allogeneic donor skin grafts are a valuable treatment option in refractory ulcers due to cGVHD but are restricted mainly to related donors while keratinocyte grafts from unrelated donors remain experimental. In male patients lacking a related donor, autologous scrotal skin graft may be an alternative option.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Doença Enxerto-Hospedeiro/cirurgia , Transplante de Células-Tronco Hematopoéticas , Queratinócitos/transplante , Úlcera Cutânea/cirurgia , Condicionamento Pré-Transplante/métodos , Adulto , Doença Crônica , Ciclofosfamida/uso terapêutico , Feminino , Sobrevivência de Enxerto/fisiologia , Doença Enxerto-Hospedeiro/imunologia , Doença Enxerto-Hospedeiro/patologia , Doença Enxerto-Hospedeiro/terapia , Humanos , Imunossupressores/uso terapêutico , Queratinócitos/citologia , Queratinócitos/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Irmãos , Pele/imunologia , Pele/patologia , Úlcera Cutânea/imunologia , Úlcera Cutânea/patologia , Úlcera Cutânea/terapia , Transplante Autólogo , Transplante Homólogo , Doadores não Relacionados , Irradiação Corporal Total
8.
Med Sci Monit ; 25: 3140-3145, 2019 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-31030206

RESUMO

BACKGROUND Regional anesthesia provides excellent analgesic effects after surgery. However, the effects of regional anesthesia on nociceptive levels during surgery under general anesthesia have not been quantitatively evaluated. To reveal the effects of thoracic paravertebral block (PVB) on nociceptive levels after skin incision during general anesthesia, we performed a retrospective cohort study in patients without serious preoperative conditions or comorbidities undergoing elective video-assisted thoracoscopic surgery (VATS). Nociceptive levels during general anesthesia were calculated using our previously determined Nociceptive Response (NR) equation, which utilizes common hemodynamic parameters. MATERIAL AND METHODS Data on 77 adult patients who underwent VATS from May 2018 to August 2018 were retrospectively obtained from our institutional database. We then performed propensity score matching between patients who received thoracic PVB (PVB group: n=29) and those who did not (Control group: n=48). The averaged values of systolic blood pressure (SBP), heart rate (HR), perfusion index (PI), bispectral index (BIS), and NR from 10 to 5 minutes before skin incision (T0), 5 to 10 minutes (T1), 10 to 15 minutes (T2), 15 to 20 minutes (T3), and 20 to 25 minutes after skin incision (T4), were calculated. RESULTS Twenty-four propensity score-matched patients in each group were analyzed. Mean NR values at T1 and T2 in the PVB group were significantly lower than those in the Control group. SBP, HR, PI, and BIS, however, showed no significant differences between the 2 groups, except for SBP at T2. CONCLUSIONS Thoracic PVB prevented an increase in NR values, which quantitatively represent nociceptive levels under general anesthesia, in patients undergoing VATS.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Procedimentos Cirúrgicos Dermatológicos/métodos , Bloqueio Nervoso/métodos , Dor Nociceptiva/prevenção & controle , Dor Pós-Operatória/prevenção & controle , Idoso , Anestesia por Condução/métodos , Anestesia Geral/métodos , Estudos de Coortes , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Monitorização Intraoperatória/métodos , Medição da Dor , Pontuação de Propensão , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos
9.
Plast Reconstr Surg ; 143(4): 1147-1153, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30921134

RESUMO

BACKGROUND: When treating a patient with a unilateral cleft lip, the goal is to try and achieve a result that is the least perceivable at conversational distance. The result should be a balanced and symmetric lip with scars that are hidden or are placed in natural anatomical lines. Several methods have been described to repair the lip. The most popular repairs at present are the rotation-advancement or its modifications and the various versions of the straight-line repair. METHODS: In the author's unit, a method has evolved entitled the symmetric philtral column repair. In this method, the author attempts to achieve a philtral column that mirrors the philtral column on the normal side, producing a balanced appearing lip. This method has been used for the past 14 years in over 500 patients. RESULTS: The results have been satisfying, with a lip revision rate of 6 percent. CONCLUSIONS: The symmetric philtral column repair of a unilateral cleft lip is an effective and safe repair. The repair is easy to understand and produces results that minimize the stigmata of a cleft lip deformity.


Assuntos
Fenda Labial/cirurgia , Procedimentos Cirúrgicos Dermatológicos/métodos , Adolescente , Criança , Pré-Escolar , Cicatriz/prevenção & controle , Feminino , Humanos , Masculino , Estudos Retrospectivos , Retalhos Cirúrgicos
10.
Artigo em Inglês | MEDLINE | ID: mdl-30901069

RESUMO

Collagenomas are connective tissue nevi with hamartomatous proliferations of dominant dermal collagen. They can present as solitary or multiple inherited or acquired lesions over various body sites. The face is a rare site of collagenomas and, of the few cases reported in the literature, they have been seen more often on the scalp or on the plantar area. An extensive literature search did not reveal any cases of isolated collagenoma on the face. Herein we present the case of 22-year-old female with isolated collagenoma on the face. This case is being reported because of its unique location and rarity.


Assuntos
Colágeno/metabolismo , Nevo/patologia , Nevo/cirurgia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Biópsia por Agulha , Procedimentos Cirúrgicos Dermatológicos/métodos , Face , Feminino , Humanos , Imuno-Histoquímica , Índia , Doenças Raras , Medição de Risco , Resultado do Tratamento , Adulto Jovem
11.
J Bone Joint Surg Am ; 101(5): 392-399, 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30845033

RESUMO

BACKGROUND: Patients, particularly those who are young, often develop noticeable orthopaedic scars. In order to achieve minimal scarring, surgeons should attempt to place incisions in skinfolds or skin creases. METHODS: Optimal incision lines can be determined from the direction of stretch marks (striae distensae), which develop perpendicular to lines of tension or main folding lines. A composite diagram of photographs of 213 individuals with striae distensae was created and compared with 276 images of incisions and scars derived from the Internet. RESULTS: Classically described Langer cleavage lines often run counter to real tension lines and poorly predict the optimal direction for skin incisions. CONCLUSIONS: Whenever possible, main folding lines should be utilized as a guide in planning surgical incisions for young patients as well as for correction of problem scars.


Assuntos
Cicatriz/etiologia , Procedimentos Cirúrgicos Dermatológicos/métodos , Procedimentos Ortopédicos/efeitos adversos , Adolescente , Síndrome de Cushing/patologia , Extremidades , Feminino , Cabeça , Humanos , Masculino , Pescoço , Fotografação , Complicações Pós-Operatórias/etiologia , Envelhecimento da Pele/fisiologia , Estrias de Distensão/patologia , Tronco
12.
J Am Acad Dermatol ; 81(1): 76-90, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30872156

RESUMO

Hidradenitis suppurativa is a chronic inflammatory disorder affecting hair follicles, with profoundly negative impact on patient quality of life. Evidence informing ideal evaluation and management of patients with hidradenitis suppurativa is still sparse in many areas, but it has grown substantially in the last decade. Part I of this evidence-based guideline is presented to support health care practitioners as they select optimal management strategies, including diagnostic testing, comorbidity screening, and both complementary and procedural treatment options. Recommendations and evidence grading based on the evidence available at the time of the review are provided.


Assuntos
Produtos Biológicos/uso terapêutico , Hidradenite Supurativa/diagnóstico , Hidradenite Supurativa/terapia , Guias de Prática Clínica como Assunto , Antibacterianos , Canadá , Terapias Complementares , Procedimentos Cirúrgicos Dermatológicos/métodos , Quimioterapia Combinada , Medicina Baseada em Evidências , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , América do Norte , Editoração , Medição de Risco , Índice de Gravidade de Doença , Estados Unidos
13.
In Vivo ; 33(2): 453-464, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30804125

RESUMO

BACKGROUND/AIM: Skin extension by multiple incisions (SEMI) may be superior to split-thickness skin graft (STSG) for closure of large soft tissue defects. MATERIALS AND METHODS: Twenty-six patients who had undergone STSG were compared to 29 patients who had undergone SEMI on the extremities. Patient and Observer Scar Assessment Scale (POSAS), Dermatology Life Quality Index, Wound QoL (Quality of Life) and Short Form Health Survey 36 were used. Elasticity, thickness and skin sensation were compared between the treated and contralateral extremity. Range of motion in adjacent joints was measured. Complication rates were compared. RESULTS: A total of 55 patients with a mean follow-up of 5.5 years (range=2-9 years) were examined. Patients with STSG had significantly worse scores in POSAS. The scar was thinner, less elastic and did not provide intact sensibility. Other scores, ROM and complication rates did not differ significantly. CONCLUSION: SEMI was superior to STSG regarding patient satisfaction and scar quality.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Transplante de Pele/métodos , Lesões dos Tecidos Moles/cirurgia , Ferida Cirúrgica/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cicatriz/fisiopatologia , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pele/fisiopatologia , Lesões dos Tecidos Moles/fisiopatologia , Transplante Autólogo , Resultado do Tratamento , Cicatrização
14.
Plast Reconstr Surg ; 143(5): 1353-1360, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30789477

RESUMO

BACKGROUND: Body contouring surgery improves quality of life, weight loss, and body image after bariatric surgery. It is unclear why only a minority of the post-bariatric surgery population undergoes body contouring surgery. This study assesses overhanging skin, body satisfaction, and qualification for reimbursement of body contouring surgery in a Dutch post-bariatric surgery population. METHODS: Post-bariatric patients were selected from a prospective database. Electronic questionnaires evaluated demographics, desire for body contouring surgery, excess skin, and satisfaction with their body. RESULTS: A total of 590 patients were included: 368 patients (62.4 percent) desired body contouring surgery, 157 (26.6 percent) did not and 65 (11.0 percent) had undergone body contouring surgery. There were no significant differences between the groups regarding the percentage of patients who met the qualifications for reimbursement. Patients who desired body contouring surgery had more body parts affected by overhanging skin and more often rated the overhanging skin with a Pittsburgh Rating Scale grade 3 compared with patients without a desire to undergo body contouring surgery. The plastic surgeon was never consulted by 39.1 percent of the "desire" population; 44.1 percent of these patients met the weight criteria. CONCLUSIONS: Post-bariatric patients who desired body contouring surgery had more excess skin than patients without a desire and were less satisfied with their body. Almost half of these patients never consulted a plastic surgeon, partly because of incorrect assumptions regarding reimbursement. Plastic surgeons (together with bariatric teams) should better inform these patients about body contouring surgery possibilities.


Assuntos
Cirurgia Bariátrica , Contorno Corporal/métodos , Procedimentos Cirúrgicos Dermatológicos/métodos , Obesidade Mórbida/cirurgia , Perda de Peso , Adulto , Contorno Corporal/economia , Imagem Corporal , Procedimentos Cirúrgicos Dermatológicos/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Satisfação Pessoal , Estudos Prospectivos , Qualidade de Vida , Encaminhamento e Consulta/estatística & dados numéricos , Mecanismo de Reembolso/economia , Mecanismo de Reembolso/estatística & dados numéricos , Inquéritos e Questionários , Resultado do Tratamento
15.
J Am Acad Dermatol ; 81(1): 213-218, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30797848

RESUMO

BACKGROUND: Absorbable suture material (Fast Absorbing Gut [FG], Ethicon, Somerville NJ) is often used for patient convenience; however, the optimal diameter of FG sutures is debatable. OBJECTIVE: To determine whether the use of 6-0 FG during repair of linear cutaneous surgery wounds on the head and neck improves scar cosmesis compared with the use of 5-0 FG. METHODS: This was a prospective, randomized, split-scar intervention in patients undergoing repair of linear cutaneous wounds on the head and neck. The scar was assessed 3 months after surgery via the Physician Observer Scar Assessment Scale (POSAS), a validated instrument. RESULTS: The difference in the sum of the POSAS component scores for 6-0 FG (12.03) compared with that for 5-0 FG (13.11) was not statistically significant (P = .26). Observer overall opinion was similar for both interventions, at 2.49 for 6-0 FG vs 2.64 for 5-0 FG (P = .54). The difference in the number of complications in the 5-0 FG group (15) vs the 6-0 FG group (10) was not statistically significant (P = .40). LIMITATIONS: Single-center study with wounds limited to the head and neck in white individuals, with a predominance of men. CONCLUSION: For linear repair of cutaneous wounds, 6-0 FG was not statistically different for cosmetic outcomes, scar width, and complications compared with 5-0 FG.


Assuntos
Categute/estatística & dados numéricos , Cicatriz/prevenção & controle , Neoplasias de Cabeça e Pescoço/cirurgia , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Cicatrização/fisiologia , Adulto , Categute/efeitos adversos , Procedimentos Cirúrgicos Dermatológicos/métodos , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Método Simples-Cego , Neoplasias Cutâneas/patologia , Técnicas de Sutura , Suturas/efeitos adversos
16.
Dermatol Online J ; 25(1)2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30710897

RESUMO

Although most dermatologic procedures are done in an office setting, some providers are performing them instead in ambulatory surgery centers (ASCs). This relocation of care comes with significantly higher expenses for patients and insurers. Compounding the issue of increased costs is the paucity of evidence demonstrating better outcomes associated with the use of ASCs. The most common cutaneous procedures have low complication rates when performed in an office setting and regular use of ASCs for these procedures is not justified.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Gastos em Saúde , Consultórios Médicos , Centros Cirúrgicos , Análise Custo-Benefício , Procedimentos Cirúrgicos Dermatológicos/economia , Dermatologistas , Humanos , Segurança do Paciente , Cirurgiões , Cirurgia Plástica
17.
Hautarzt ; 70(3): 215-227, 2019 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-30701288

RESUMO

Merkel cell carcinoma is a rare, highly aggressive skin tumor with neuroendocrine features found in older people. The pathogenesis is associated with immunosuppression, chronic UV light exposure and the Merkel cell polyomavirus. Clinically, Merkel cell carcinoma presents as a solitary, cutaneous or subcutaneous, red to bluish node. Due to early lymphogenic metastasis, locoregional metastases are already present in approximately 30% of cases at the time of diagnosis. The frequent local recurrences as well as the regional and distant metastases usually appear within the first 2-3 years after the initial diagnosis. The first treatment after diagnosis consists of complete surgical removal of the primary tumor with wide safety margins as well as a sentinel lymph node biopsy. Subsequently, adjuvant irradiation of the primary site should be performed. By additional radiotherapy of the regional lymph node stations, the rate of locoregional recurrence can be reduced. For systemic therapy of advanced Merkel cell carcinoma checkpoint inhibitors targeted against the PD-1/PD-L1 axis have proven to be highly and durably effective. In contrast the formerly frequently used chemotherapy shows moderate to good response rates but they are as a rule very short-lived.


Assuntos
Carcinoma de Célula de Merkel/patologia , Carcinoma de Célula de Merkel/terapia , Procedimentos Cirúrgicos Dermatológicos/métodos , Excisão de Linfonodo , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Radioterapia Adjuvante/métodos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Célula de Merkel/cirurgia , Terapia Combinada/métodos , Humanos , Metástase Linfática , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/cirurgia
18.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(1): 33-37, ene.-feb. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-176884

RESUMO

Introducción y objetivos: El efecto en trampilla o trapdoor es una complicación posible en un colgajo cuando se utiliza especialmente en la zona facial. Consta de una deformidad elevada y abultada, que comienza 3 semanas después de la intervención, y hasta la fecha no existe consenso en su tratamiento. Es por ello que presentamos nuestra experiencia en esta afección, destacando la técnica de afeitado profundo o super shaving para la resolución del efecto en trampilla de colgajos nasales. Materiales y métodos: Estudio retrospectivo y descriptivo de 10 pacientes que desarrollaron un abultamiento posterior a un cierre mediante colgajo en la zona nasal, que fueron resueltos quirúrgicamente a través de la técnica de super shaving y su manejo postoperatorio. Resultados: La edad mediana de los 10 pacientes operados fue 67,7 años, y todos ellos presentaron abultamiento de colgajo de trasposición del área nasal, posterior a una cirugía micrográfica de Mohs o cirugía convencional. El tiempo de aparición de la complicación fue de aproximadamente 5 semanas, y el de cicatrización fue de 4 semanas. Ningún paciente presentó complicaciones mayores en el postoperatorio, y la cicatriz tuvo una incidencia estética baja comparada con el abultamiento. Todos los pacientes refirieron estar muy satisfechos con el resultado estético. Conclusiones: Consideramos que la técnica de super shaving es rápida, efectiva, simple, de bajo costo, se practica de manera ambulatoria, y ofrece resultados estéticamente excelentes para resolver este defecto


Introduction and objectives: The trapdoor effect is a possible complication in flap reconstructions, particularly those involving the face. It consists of a bulging, elevated deformity that appears 3 weeks after the intervention. To date there has been no consensus on how the trapdoor effect should be treated. The aim of this article is to report on our experience with this defect and describe how we use the 'super shaving' technique to resolve the trapdoor effect in nasal flaps. Material and methods: We performed a retrospective, descriptive study of 10 patients who developed a bulging deformity of a nasal flap that was treated surgically with the super shaving technique. We also report on postoperative management. Results: The median age of the 10 patients was 67.7 years and they all developed a bulging transposition flap in the nasal area after conventional or Mohs micrographic surgery. The complication occurred approximately 5 weeks after surgery and healing time was 4 weeks. There were no major postoperative complications and the outcome was of low aesthetic significance compared with the bulging flap. All the patients stated they were very satisfied with the aesthetic outcome. Conclusions: In our opinion, the super shaving technique is a fast, effective, simple, and cheap outpatient procedure that offers excellent aesthetic results


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Retalhos Cirúrgicos , Rinoplastia/métodos , Neoplasias Nasais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Cirurgia de Mohs/métodos , Inflamação/complicações , Procedimentos Cirúrgicos Dermatológicos/métodos , Nariz/patologia , Nariz/cirurgia , Deformidades Adquiridas Nasais/patologia , Deformidades Adquiridas Nasais/cirurgia
20.
Dermatol Surg ; 45(9): 1141-1146, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30672859

RESUMO

BACKGROUND: Elliptical excision (EE) has been the standard surgical technique for the removal of epidermal cysts. However, it produces to create a long, linear wound causing cosmetic concerns. OBJECTIVE: The purpose of the study was to evaluate the cosmetic outcomes and postoperative complications of rectangular lid excision (LE) compared with EE in epidermal cyst removals. METHODS: Medical records of patients who received surgical excision for epidermal cysts were retrospectively reviewed. Three dermatologists evaluated the postoperative photographs using 4-scale investigator's global assessment. RESULTS: Of the 123 lesions, EE and LE were performed in 58 and 65 lesions, respectively. Although the mean diameter of cysts was significantly greater in the LE group than in the EE group, the number of postoperative complications was not different between the 2 groups. A photographic assessment was performed in 11 lesions in the LE group and 11 lesions in the EE group. Although the mean diameter of cysts was greater in the LE group than in the EE group, the cosmetic outcome was significantly better in the LE group. CONCLUSION: The LE technique was shown to have a superior cosmetic outcome than the EE technique. Hence, it is a viable alternative for the removal of epidermal cysts.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Cisto Epidérmico/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Estética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Retalhos Cirúrgicos , Resultado do Tratamento , Adulto Jovem
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