Open Microcomedone Extraction Facilitated by Polarized Dermoscopy.

Microcomedonal lesions can be aesthetically and psychologically displeasing. The burden of comedones increases when considering their frequency and demand for time-consuming attention. The objective of the current study was to describe a novel technique to facilitate open microcomedone extraction. The instrumentation used includes smartphone photography with dermatoscopy. The dermatoscope is an effective tool for diagnosing a broad range of dermatologic conditions. The polarized dermatoscope can facilitate execution of cutaneous procedures whenever magnification and optimal illumination are necessary. Its connection to a smartphone with a unique adapter enabled single-handed examination of microcomedones. Under magnification with this unit, the involved lesions are photographed to clearly demonstrate the condition and achieve informed consent. The complete procedure can be recorded on video for documentation. In this case, four separate lesions of the left auricle of a young man were treated using direct pressure extraction. The procedure undertaken was rapid, convenient, and completed without any adverse sequelae. This procedure is recommended for similar cases using the dermatoscope, which does not require additional specific training and is readily available at no extra cost. This technique could be used in various dermatologic conditions.

Radiofrequency catheter ablation of atrioventricular node reentrant tachycardia in children with limited fluoroscopy.

BACKGROUND: Limited fluoroscopy cryo-ablation using a 3D electro-anatomical system (3DS) has been used for AVNRT in children. We aimed to facilitate a fluoroscopy limited approach of RF ablation of AVNRT in children. METHODS: A retrospective study was performed of procedure parameters in children undergoing RF ablation of AVNRT in 75 consecutive children (June 2011 to November 2013 - Group A) using standard fluoroscopy techniques compared to those of 64 consecutive children (December 2013 to May 2015 - Group B), using a fluoroscopy limited approach with 3DS. RESULTS: The acute success rate was 98.7% (74/75) and 98.4% (63/64) for groups A and B, respectively. The recurrence rate was 2.7% (2/74) and 0% (0/63) with a mean follow-up period of 45.5±12.1 and 14.3±6.1months for group A and group B, respectively. The mean procedure and fluoroscopy times were significantly lower for group B compared to group A (119±37 (43-203) and 0.83±1.04 (0.05-3.83) minutes versus 146±53 (72-250) and 16.1±8.9 (4.39-55) minutes, p<0.003 and p<0.0001, respectively). There were no ablation-related complications. CONCLUSIONS: A fluoroscopy limited approach for RF ablation of AVNRT in children using a 3DS is easily acquired and adapted, and significantly reduces the fluoroscopy and procedure time with excellent efficacy, safety and low recurrence rate. CONDENSED ABSTRACT: This study confirmed that a 3D mapping system (3DS) to guide ablations of AVNRT in children reduces radiation exposure. Combined, limited fluoroscopy and 3DS in a methodology that resembles the familiar conventional fluoroscopy approach for RF ablation of AVNRT in children is proposed. Combined limited fluoroscopy and RF-energy in children with AVNRT are associated with a shorter procedure time, minimal fluoroscopy time, a high success rate and a low recurrence rate.

The subcutaneous loop: a single suture technique for skin closure after superficial and subcutaneous surgery.

BACKGROUND: Removal of subcutaneous skin masses and certain deep skin injuries results in defects, which demand immediate closure. Although primary closure of these defects in 2 layers is an acceptable solution, this technique has a number of drawbacks, such as extended time consumption upon performance, demand for additional suture material and occasional tissue response or foreign body reaction to retained absorbable stitches leading to infection and its sequelae. OBJECTIVE: We describe an approach intended to furnish a satisfactory solution to the needs of tissue closure in such cases. The significant innovation of this technique is the closure of both deep and superficial layers of skin in one single suture. MATERIALS AND METHODS: Our suture combines the advantages of the classic mattress suture together with those of the buried subcutaneous suture. We performed the vertical mattress suture with 3/0 polypropylene or monofilament suture and added a subcutaneous loop to achieve sufficient approximation of deep tissue surfaces. This suture technique was applied in our first 50 cases. The defects were closed without adverse sequelae. No tissue infections were observed. Wound dehiscence occurred in one case after premature suture removal. The stitches were slightly more difficult to remove than regular sutures. Review of the resulting scars exhibited acceptable results similar to those of parallel closure techniques. CONCLUSIONS: This easily performed technique yields the benefits of reducing suture cost, annulling foreign body reaction, and resulting in both a functional and aesthetically pleasing outcome. The subcutaneous loop technique has become our standard closure of choice for wounds demanding simultaneous cutaneous and subcutaneous repair.

Control of traumatic wound bleeding by compression with a compact elastic adhesive dressing.

OBJECTIVE: Compression dressing has been assumed effective, but never formally examined in the field. METHODS: A prospective interventional trial examined efficacy and feasibility of an elastic adhesive dressing compression device in the arena of the traumatic incident. The primary variable examined was the bleeding rate from wounds compared before and after dressing. RESULTS: Sixty-two consecutive bleeding wounds resulting from penetrating trauma were treated. Bleeding intensity was profuse in 58%, moderate 23%, and mild in 19%. Full control of bleeding was achieved in 87%, a significantly diminished rate in 11%, and, in 1 case, the technique had no influence on the bleeding rate. The Wilcoxon test for variables comparing bleeding rates before and after the procedure obtained significant difference (Z = -6.9, p < 0.01). No significant complications were observed. Caregivers were highly satisfied in 90% of cases. CONCLUSION: Elastic adhesive dressing was observed as an effective and reliable technique, demonstrating a high rate of success without complications.

Evaluation of techniques for intravenous catheter and tubing fixation.

OBJECTIVE: The aim of this study was to examine two techniques intended to prevent accidental displacement of intravenous catheters after proper establishment of infusion line access. METHODS: After catheter insertion and taping in position, fixation with gauze roll sequentially wrapped around the limb across which the tubing has been extended was compared with the use of a polyethylene roll manipulated by an attached "handle." The experimentation was performed on medical personnel serving as live models. RESULTS: Thirty-eight trials were conducted with 19 of each fixation technique. The variables measured were: time consumption, convenience, general satisfaction, and success score of the fixation. All of the measurements showed that the polyethylene roll was significantly the superior of the two methods. Despite forceful tugging of the tubing, polyethylene fixation virtually prevented any displacement whatsoever and was more than twice as rapid. CONCLUSIONS: We demonstrate a novel device allowing faster and more efficacious fixation of the infusion drip tubing and catheter suggested as the technique of choice in emergency medical field care.

Evaluation of techniques for treating the bleeding wound.

BACKGROUND: Despite the fact that the urgent control of active bleeding from external body surfaces demands a basic procedure, it is puzzling that this topic has received little if any attention in modern medical research. Elastic adhesive dressing (ELAD) has been proposed for dressing the bleeding wound. METHODS AND MATERIALS: Three techniques were compared over a simulated wound in a human model. Pressures generated between the chosen dressing surface and the underlying mock wound's cutaneous surface, time consumption, convenience, satisfaction and pain were tested for each technique. RESULTS: Sixty-eight experiments were performed over nine separate anatomical sites. Average pressures for field dressing, ELAD and manual compression were 33, 88 and 180 mmHg, respectively; these differences in pressure were statistically significant. Manual pressure was equally inconvenient for both patient and caregiver. The more proximal and wider anatomical regions were more difficult and time consuming to compress. The caregivers graded ELAD the highest level of convenience and general satisfaction. CONCLUSIONS: Field bandage testing reflected its inadequacy in controlling bleeding from most body regions. The results suggest that ELAD may be the hands-free technique of choice. We hope that this article will stimulate further research and elicit evidence on precisely which technique is most suitable for various anatomical location.

Office treatment of congenital ankyloglossia.

BACKGROUND: Congenital oral adhesions may pose both aesthetic and functional disturbing ailments to wary parents. Most of these as we have experienced, are benign, easily cured and may be treated as soon as possible in the office. A local survey elucidated that these youngsters are usually advised to wait until one year of age and then taken into the operating room and incision of the adhesion is performed under general anesthesia. We assessed the benign nature of this ailment and relative avascularity of the tissue involved and concluded that with minimal risk an office procedure under local anesthesia can replace current practice. We also found that most referrals with this condition present with the lowest grade of severity of ankyloglossia, amenable to a very brief intervention. MATERIAL/METHODS: During the period 1998-2002 we diagnosed nineteen congenital lesions in thirteen patients. All children were treated in a community clinic setting using electrocautery under local anesthesia. Surgical success was defined as significant improvement in the ability to protrude the tongue outwards beyond the gums and teeth. Gingival adhesions were judged by release of soft tissue adhesions. RESULTS: Tongue Surgical success was accomplished in all cases with minimal discomfort and without complications. In one single case the previous functional limitation was not relieved. CONCLUSIONS: Our experience indicates that office-based electrocautery dissection is an efficacious economical and safe treatment of mild congenital oral adhesions. We recommend this method as therapy of choice for such lesions.

Control of massive bleeding from facial gunshot wound with a compact elastic adhesive compression dressing.

The issue of immediate control of acute external traumatic hemorrhage is poorly dealt with in the medical literature. A compact unit incorporating the desired components capable of applying significant compression over diverse body areas has been suggested in the past but not formally demonstrated effective in practice. In this report we describe the treatment of a young man presenting with a very large, complex, profusely bleeding facial gunshot wound. The calvarium remained intact. The upper airway was diverted and secured by performing a cricothyroidotomy. A transparent elastic adhesive dressing was then applied by covering the anterior aspect of the face by a contact pad followed by sequential wrapping of the roll covering all structures between the forehead and the neck. This procedure successfully controlled the hemorrhage and maintained the victim's condition hemodynamically stable until definitive surgical intervention at the level 1 medical center. We attribute the survival of this victim to the innovative dressing technique and excellent cooperation between the trauma team and hospital staff. This case demonstrates the contribution of elastic adhesive compression dressing towards saving the lives of those inflicted by severely challenging bleeding wounds. We suggest this technique be considered by Emergency personnel working in the prehospital arena in selected cases.