Journal of Cutaneous and Aesthetic Surgery
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   Table of Contents - Current issue
July-September 2014
Volume 7 | Issue 3
Page Nos. 141-186

Online since Wednesday, December 10, 2014

Accessed 1,940 times.

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Risk assessment and prevention of complications in aesthetic surgery p. 141
Niti Khunger
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Basal cell carcinoma of the outer nose: Overview on surgical techniques and analysis of 312 patients Highly accessed article p. 143
Uwe Wollina, Annett Bennewitz, Dana Langner
Background: Basal cell carcinoma of the nose is common, with a potential of local recurrence and high-risk features. Materials and Methods: We provide a review on anatomy of the nose, tumour surgery and defect closure on the nose. We analysed our own patients with nasal BCC of a 24 months period. Results: We identified 321 patients with nasal BCC. There was a predominance of female patients of 1.2 to 1. The mean age was 74.8 years. Slow Mohs technique was employed for all tumours until 3D tumour-free margins were achieved. That resulted on average in 1.8 ± 0.7 Mohs stages. The most common histologic types were solitary (n = 182), morpheic (79), and micronodular (20), Perineural infiltration was evident in 56 tumours. Primary closure after mobilisation of soft tissue was possible in 105 BCCs. Advancement flaps were used in 91 tumours, rotation flaps in 47, transposition flaps in 34 tumours, and combined procedures in 6 cases. In 36 patients full-thickness skin grafting was performed. In two patients healing by second intention was preferred. Partial flap loss was seen in four patients (1.4%). All of them had significant underlying pathologies. None of the tumours treated showed a relapse during the observation time. However, this is a limitation of the present study since follow-up was on average only 10 months. Conclusions: BCCs of the nose are common. Only 3D-controlled micrographic surgery (Mohs or slow Mohs) guarantee a high rate of complete tumour removal and a very low risk of recurrence.
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Adjuvant narrow band UVB improves the efficacy of oral azithromycin for the treatment of moderate to severe inflammatory facial acne vulgaris p. 151
Sima Rassai, Esmaeil Rafeie, Marigdalia K Ramirez-Fort, Amir Feily
Background: Acne vulgaris (AV) is a common inflammatory disease of the pilosebaceous unit. A variety of treatment modalities are available for the treatment of AV. Among the available options, oral azithromycin is popularly prescribed for its proven anti-inflammatory effects. Narrow band UVB (NBUVB) also has a potent anti-inflammatory action. Concomitant use of both modalities may result in a synergistic therapeutic response; however, the combined efficacy has not yet been evaluated for the treatment of inflammatory AV. Objective: The aim of this study was to compare the efficacy of oral azithromycin plus NBUVB (peak 311 nm) to oral azithromycin alone for the treatment of moderate to severe inflammatory AV. Materials and Methods: A randomized, open-label, clinical trial was conducted over 4 weeks. Subjects were randomized into two groups. Group 1 received 500 mg of oral azithromycin three times per week. Group 2 received 500 mg of oral azithromycin plus NBUVB three and two times per week, respectively. Concomitant topical or oral AV treatments were not permitted during the treatment period. Response to treatment was measured by photographic records at the primary endpoint (2 weeks) and at the end of treatment. Results: One hundred and four subjects were enrolled in the trial; 94 subjects completed the treatment period of the study. Group 2 demonstrated significant clinical improvement of the inflammatory papular lesions (88.55%) compared with group 1 (70.34%) at the end of treatment (P = 0.002). The clinical response of pustular (P = 0.562), nodular (P = 0.711) and cystic (P = 0.682) lesions did not significantly differ between the two treatment groups. Interestingly, response to treatment in group 2 had a significant anatomical predilection for the forehead (P = 0.023). There was no side-effect except erythema, which subsided within 1-2 days. Conclusion: NBUVB plus oral azithromycin is more effective than oral azithromycin alone for treating papular lesions of inflammatory AV. NBUVB is certainly a viable adjunct in acne therapy.
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A retrospective study of Marjolin's ulcer over an eleven year period p. 155
Vasu Reddy Challa, Vijayalakshmi Deshmane, Madhusudana Bommasandra Ashwatha Reddy
Background: Marjolin's ulcer is a rare aggressive cutaneous malignancy occurring in previously occurred wounds. The most common aetiology is a burn wound involving extremities and squamous cell carcinoma is the most common variant. Materials and Methods: A retrospective analyses of medical records of patients treated in a single unit with a diagnosis of Marjolin's ulcer was performed. Results: During the study period, 14 patients were treated. Four patients had lymph node metastases and one had pulmonary metastases at the time of presentation. Seven patients underwent wide excision with reconstruction and seven underwent amputation or disarticulation because of advanced malignancy. During the follow up two patients developed local recurrence and one developed pulmonary metastases. Both the patients with pulmonary metastases had Marjolin's ulcer of trunk. Conclusion: Marjolin's ulcer occurs more commonly in the extremities. Distant metastases occur commonly in patients with ulcers on the of trunk.
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The rhombic bilobed flap, a simple, geometrically designed flap p. 160
Yoshiaki Sakamoto, Hideo Nakajima, Kazuo Kishi
We describe a combination of the common rhomboid flap and bilobed flap and provide an example of its use. The rhombic bilobed flap is simple to use and is associated with fewer complications, such as pin-cushioning and standing cone deformities, while minimizing the risk of skin necrosis and tension on the flap.
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Anoscrotal median raphe sinus in a child p. 162
Anand Pandey, Rajesh Verma, Vipin Gupta, Shailendra Pal Singh
Anoscrotal median raphe sinus is an extremely rare entity in children. We report a pediatric patient and describe the management of this condition.
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Gauze strip tourniquet for nail surgery p. 164
Chander Grover, Soni Nanda, Belum Siva Nagi Reddy
All nail surgical procedures require the use of a tourniquet. The nail bed, being a very vascular structure, needs to be exsanguinated at the start and then a tourniquet needs to be tied at the base. A number of tourniquets have been described, including a Foley's catheter, a Penrose drain, a rubber strip or a rubber band. The present article explains the use of the easily available, improvised, gauze strip tourniquet. This does not require much special preparation, is easily autoclavable, perfect for single use and can achieve exsanguination as well as tightening as a single step. This technique does not require much learning and is easily reproducible in almost all surgical setups.
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Essential requirements to setting up an aesthetic practice p. 167
Mukta Sachdev, Gillian R Britto
Aesthetic dermatology is becoming a vital and popular branch of medicine. This article aims to guide dermatologists to set up a professional and ethical aesthetic practice. Dermatologists should have an integrated practice of clinical dermatology, dermatosurgery and cosmetic dermatology. Ethical practice is the gold standard for any medical field, especially with dermatologists, who should avoid doing unnecessary procedures. Proper patient counselling and addressing the patients' concerns is imperative.
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A rare case of synchronous saree cancer p. 170
N Naveen, M Kamal Kumar, Ramesh K Babu, Prema Dhanraj
Skin cancers are rather uncommon malignancies comprising less than 1% of all the cancers in India. Saree cancer is a rare type of squamous cell carcinoma (SCC). Saree and dhoti are traditional male and female costumes respectively, which is unique to the Indian subcontinent. Constant wear of this clothing tightly around the waist results in changes in pigmentation and scaling of the skin, acanthosis, scar and ulceration and subsequent, gradual malignant changes. The process of repeated trauma over a long time and consequent interference with the healing process may rationalise the reason for malignant transformation. Few papers have been published on saree cancer, in main stream medical journals. We are presenting a rare case of saree cancer in a 68-year-old woman, with two distant bilateral ulceroproliferative growths in loin (Synchronous), along the waistline, which showed well-differentiated SCC on biopsy. Wide excision with rhomboid transposition flap was done bilaterally.
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Facial fat necrosis following autologous fat transfer and its management p. 173
Sweta Rai, Alexander M Marsland, Vishal Madan
Autologous fat transfer (AFT) is an increasingly popular cosmetic procedure practiced by dermatologic surgeons worldwide. As this is an office based procedure performed under local or tumescent anaesthesia with fat transferred within the same individual and limited associated down time its is considered relatively safe and risk free in the cosmetic surgery arena. We describe a case of AFT related fat necrosis causing significant facial dysmorphia and psychosocial distress. We also discuss the benefits and risks of AFT highlighting common causes of fat graft failure.
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Mutaf triangular flap technique in the repair of infraorbital skin losses: Report of 5 cases p. 176
Roberto Cecchi, Laura Bartoli, Luigi Brunetti, Giovanni Troiano
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Side-effects from follicular unit extraction in hair transplantation p. 177
Marc R Avram, Nicole Rogers, Shannon Watkins
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Unusual location of glomus tumour on the right ring finger p. 179
Ami Dedhia, Swagata Tambe, Raviraj Jadhav, Kalpana Bhatt, Hemangi Jerajani
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Large skin tags on the thigh p. 181
Keshavmurthy A Adya, Aparna Palit, Arun C Inamadar
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Re: Superficial large basal cell carcinoma over the face, reconstructed by V-Y plasty p. 183
Gary Ross
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Re: Utility of gel nails p. 184
Sim Sai Tin, Viroj Wiwanitkit
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Creating recipient sites using custom cut razor blades in hair transplantation Highly accessed article p. 184
Renita Lourdhurajan, Anandan Subramanian, Adi Krishnan Swaminathan, Aarthi Senthil Ganesh
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