RESUMEN
BACKGROUND: Full thickness defects of the ala, soft triangle, and nasal tip involving the nasal lining have traditionally been repaired with the three-stage folded paramedian forehead flap (FPFF), with a cartilage graft for support. For similar defects, the authors utilize the two-stage FPFF without cartilaginous support which provides reproducible functional and aesthetic results. Objective: To describe the authors’ experience with the two-stage FPFF, including outcomes, complications, and design modifications to enhance functional and aesthetic success. Methods: An IRB-approved retrospective database review of FPFF was performed at two sites. Using postoperative photographs, outcomes were assessed by blinded non-investigator dermatologist raters using a modified observer scar assessment scale. RESULTS: Thirty-five patients were reconstructed using the two-stage FPFF without cartilage grafts. Subjective assessment of scar vascularity, pigment, relief, and thickness by 3 independent reviewers yielded an overall cosmesis score of 8.4±1.9 (out of 40). CONCLUSION: The two-stage FPFF without cartilage grafts is a reliable, cosmetically elegant repair that can provide optimal functional and aesthetic results for complex unilateral distal nose defects.J Drugs Dermatol. 2024;23(4): doi:10.36849/JDD.7358.
Asunto(s)
Neoplasias Nasales , Rinoplastia , Humanos , Rinoplastia/métodos , Colgajos Quirúrgicos , Estudios Retrospectivos , Frente/cirugía , Cicatriz/patología , Nariz/cirugía , Cartílago/trasplante , Neoplasias Nasales/cirugía , Neoplasias Nasales/patologíaRESUMEN
Primary cutaneous angiosarcoma (cAS) of the head and neck is a rare sarcoma with a poor prognosis and limited treatment options. We conducted a systematic review of treatments used for head and neck cAS and determined the treatment modalities that offer the longest mean overall survival (OS). Forty publications totaling 1295 patients were included. Both surgical and nonsurgical modalities have shown potential efficacy in the treatment of cAS; however, limited data preclude definitive recommendations. Multidisciplinary management of cAS should be considered to tailor treatment on a case-by-case basis.
Asunto(s)
Neoplasias de Cabeza y Cuello , Hemangiosarcoma , Sarcoma , Humanos , Hemangiosarcoma/diagnóstico , Hemangiosarcoma/terapia , Pronóstico , Estudios Retrospectivos , Terapia Combinada , Neoplasias de Cabeza y Cuello/terapiaAsunto(s)
Frente , Rinoplastia , Humanos , Frente/cirugía , Colgajos Quirúrgicos/cirugía , Nariz/cirugíaRESUMEN
BACKGROUND: Suture removal after surgery is low risk; however, it is often performed by a medical provider. The current SARS-CoV-2 pandemic has forced providers to assess means of reducing in-person contact. OBJECTIVE: To determine whether patients undergoing Mohs surgery are willing and successful with home suture removal. MATERIALS AND METHODS: A prospective study was performed with patients undergoing Mohs surgery. Before their surgery, patients were assessed for their willingness to remove sutures before and after viewing educational material. Patients who were willing to attempt removal were contacted after expected suture removal date to verify success and assess their experience. RESULTS: One hundred fifty patients were enrolled in the study. 90.1% were willing to attempt home suture removal. Patients were more willing ( p = .003), more confident ( p = .024), and had lower anxiety ( p = .049) with removal after viewing educational resources. Patients with a history of suture removal were more likely to attempt removal after their procedure ( p = .036). Ninety-seven percent of patients who were willing to attempt suture removal were successful. There were no major complications with removal. CONCLUSION: Patients were overwhelmingly successful with suture removal after an educational intervention. Providers should consider providing this option after surgical procedures when clinically appropriate.
Asunto(s)
COVID-19 , Cirugía de Mohs , COVID-19/epidemiología , COVID-19/prevención & control , Humanos , Cirugía de Mohs/efectos adversos , Estudios Prospectivos , SARS-CoV-2 , Técnicas de Sutura , SuturasAsunto(s)
Remoción del Cabello , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Remoción del Cabello/efectos adversos , Humanos , Cirugía de Mohs , Cuidados Preoperatorios , Estudios Retrospectivos , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & controlAsunto(s)
Carrera , Suturas , Procedimientos Quirúrgicos Dermatologicos , Humanos , Técnicas de SuturaAsunto(s)
Melanoma/cirugía , Cirugía de Mohs/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Neoplasias Cutáneas/cirugía , Adulto , Estudios Transversales , Becas/estadística & datos numéricos , Femenino , Secciones por Congelación , Humanos , Inmunohistoquímica , Masculino , Melanoma/patología , Persona de Mediana Edad , Cirugía de Mohs/educación , Neoplasias Cutáneas/patología , Coloración y Etiquetado , Encuestas y Cuestionarios , Estados UnidosAsunto(s)
Procedimientos Quirúrgicos de Citorreducción/estadística & datos numéricos , Melanoma/cirugía , Cirugía de Mohs/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Neoplasias Cutáneas/cirugía , Adulto , Biomarcadores de Tumor/análisis , Estudios Transversales , Procedimientos Quirúrgicos de Citorreducción/métodos , Femenino , Humanos , Inmunohistoquímica/estadística & datos numéricos , Antígeno MART-1/análisis , Masculino , Márgenes de Escisión , Melanoma/diagnóstico , Melanoma/patología , Persona de Mediana Edad , Cirugía de Mohs/métodos , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Piel/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , Cirujanos/estadística & datos numéricos , Encuestas y Cuestionarios/estadística & datos numéricosRESUMEN
BACKGROUND: Direct oral anticoagulants (DOACs), such as apixaban, rivaroxaban, and dabigatran, are increasingly being used to provide prophylaxis and treatment for arterial and venous thromboembolism. Multiple procedural subspecialties have implemented guidelines detailing time frames for perioperative DOAC interruption; however, the impact of perioperative DOAC interruption in patients undergoing dermatologic surgery is currently unknown, and evidence-based guidelines are lacking. OBJECTIVE: To assess the 30-day postoperative rate of thrombotic complications (ischemic stroke, transient ischemic attack, systemic embolism, deep vein thrombosis [DVT] and pulmonary embolism) in patients with nonvalvular atrial fibrillation (AF) or a history of DVT who underwent perioperative DOAC interruption during dermatologic surgery. METHODS: A retrospective medical record review was performed of all patients with AF or a history of DVT who underwent perioperative DOAC interruption during dermatologic surgery at Advanced Dermatologic Surgery and the University of Kansas Medical Center between January 1, 2016, and August 31, 2020. RESULTS: Among 806 operations, comprising 750 Mohs micrographic operations (93.1%) and 56 excisions (6.9%), 1 patient (0.14% of patients with AF) sustained a transient ischemic attack and 2 patients (0.25% of all patients) sustained minor bleeding complications during the 30-day postoperative period. CONCLUSION: Perioperative DOAC interruption appears to be safe and efficacious in dermatologic surgery.
Asunto(s)
Anticoagulantes/administración & dosificación , Fibrilación Atrial/tratamiento farmacológico , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Ataque Isquémico Transitorio/epidemiología , Hemorragia Posoperatoria/epidemiología , Administración Oral , Anciano , Anciano de 80 o más Años , Anticoagulantes/efectos adversos , Anticoagulantes/normas , Fibrilación Atrial/complicaciones , Dabigatrán/administración & dosificación , Dabigatrán/efectos adversos , Femenino , Humanos , Ataque Isquémico Transitorio/etiología , Ataque Isquémico Transitorio/prevención & control , Masculino , Atención Perioperativa/normas , Atención Perioperativa/estadística & datos numéricos , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/prevención & control , Pirazoles/administración & dosificación , Pirazoles/efectos adversos , Piridonas/administración & dosificación , Piridonas/efectos adversos , Estudios Retrospectivos , Rivaroxabán/administración & dosificación , Rivaroxabán/efectos adversosAsunto(s)
Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Neoplasias de Cabeza y Cuello/cirugía , Cuero Cabelludo/cirugía , Neoplasias Cutáneas/cirugía , Herida Quirúrgica/cirugía , Procedimientos Quirúrgicos Dermatologicos , Humanos , Inyecciones , Cuero Cabelludo/anatomía & histología , Colgajos QuirúrgicosRESUMEN
Limited data exist comparing staples and sutures for closing scalp wounds during Mohs micrographic surgery (MMS). We surveyed practicing Mohs surgeons who were members of the American College of Mohs Surgery (ACMS) on their scalp wound closure preferences as well as the clinical and economic variables that impact their decisions. Comparisons were made between current practice habits, preferences, and provider demographics. Sixty-eight ACMS fellowship-trained Mohs surgeons completed the survey. Overall, scalp wounds during MMS were most frequently closed using staples.
Asunto(s)
Cirugía de Mohs/métodos , Grapado Quirúrgico/estadística & datos numéricos , Técnicas de Sutura/instrumentación , Suturas/estadística & datos numéricos , Adulto , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Cirugía de Mohs/instrumentación , Pautas de la Práctica en Medicina/estadística & datos numéricos , Cuero Cabelludo/cirugía , Cirujanos/estadística & datos numéricos , Técnicas de Sutura/estadística & datos numéricosRESUMEN
BACKGROUND: The increased use of Mohs micrographic surgery (MMS) to treat melanoma has been accompanied by wide variations in practice patterns and a lack of best practice guidelines. OBJECTIVE: The present study was a nationwide cross-sectional survey of Mohs surgeons to elucidate commonalities and variations in their use of MMS to treat melanoma. MATERIALS AND METHODS: A cross-sectional analysis was performed using survey responses of Mohs surgeons with membership in the American College of Mohs Surgery. RESULTS: A total of 210/513 (40.9%) participants used MMS to treat melanoma of any subtype and 123/210 (58.6%) participants within this group treated invasive T1 melanoma (AJCC Eighth Edition) with MMS. A total of 172/210 (81.9%) participants debulked melanoma in situ (MIS). Average margin size of the first Mohs stage for MIS was 4.96 ± 1.74 mm. A total of 149/210 (71.0%) participants used immunohistochemical stains, with 145/149 (97.3%) using melanoma antigen recognized by T-cells 1 (MART-1) in 96.5% of melanoma cases treated with MMS. CONCLUSION: Over half of surveyed Mohs surgeons treating melanoma with MMS are treating early invasive melanoma with MMS. Most Mohs surgeons treating melanoma with MMS debulk MIS and virtually all use MART-1 when excising invasive melanoma with MMS.