Journal of Cutaneous and Aesthetic Surgery
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   Table of Contents - Current issue
Coverpage
January-March 2017
Volume 10 | Issue 1
Page Nos. 1-63

Online since Monday, April 17, 2017

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EDITORIAL  

Accelerated wound healing: Harnessing the power of platelets, biomaterials, stem cells and gene therapy p. 1
Niti Khunger
DOI:10.4103/JCAS.JCAS_32_17  
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ORIGINAL ARTICLES Top

Autologous platelet-rich fibrin matrix in non-healing trophic ulcers in patients with Hansen's disease p. 3
Umashankar Nagaraju, Priya K Sundar, Priyanka Agarwal, Belliappa P Raju, Mahesh Kumar
DOI:10.4103/JCAS.JCAS_17_16  
Background: Non-healing trophic ulcers in Hansen's disease patients is one of the major causes for disability. It has been shown that autologous platelet-rich fibrin matrix (PRFM) is effective in healing chronic non-healing leg ulcers. Aim: The objective of this study is to demonstrate the efficacy of autologous platelet-rich fibrin matrix (PRFM) in non-healing trophic ulcers in patients treated for Hansen's disease. Design: A prospective study. Setting: An institution-based clinic. Participants: Seven treated patients with Hansen's disease, with a mean age of 38.33 years, with nine non-healing trophic ulcer of more than 6 weeks duration. Measurements: Photographs were taken before treatment and at every subsequent sitting. Area and volume were calculated at baseline and every subsequent sitting till the closure was achieved. Materials and Methods: The healthy ulcers were treated with PRFM at weekly intervals, repeated once a week for a maximum of five sittings as per requirement. Results: The mean percentage improvement in the area was 93.52%, and volume was 97.74% at the end of the second sitting. All ulcers closed by a maximum of five sittings. No adverse events were noted. Conclusion: PRFM for the treatment of trophic ulcers in treated patients with Hansen's disease is a feasible, safe, simple and inexpensive method.
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Comparison of efficacy of autologous platelet-rich fibrin versus saline dressing in chronic venous leg ulcers: A randomised controlled trial p. 8
Anirudh Somani, Reena Rai
DOI:10.4103/JCAS.JCAS_137_16  
Background: Venous leg ulcer is a chronic condition, and various treatment modalities are available. Platelet-rich fibrin (PRF) is one of the newer modalities and it contains fibroblast growth factor (GF), vascular endothelial GF, angiopoitin and platelet-derived GF which enhances the wound healing. Hence, we conducted a randomised controlled trial to compare the efficacy of PRF versus saline dressing in chronic venous leg ulcers. Aim: This study aims to compare the efficacy of autologous PRF with saline dressing in patients with chronic venous leg ulcer and to compare the mean reduction in ulcer area at the end of 4 weeks. Materials and Methods: Fifteen patients with chronic venous leg ulcers of >6 months duration having an ulcer area of 1 cm × 1 cm to 5 cm × 5 cm were taken into the study and were randomly divided into two groups. Group 1: Patients received PRF dressing. Ten millilitres of patient's blood was taken and centrifuged at 3000 rpm for 15 min. A fibrin clot obtained in the middle of the tube was removed and used for dressing over the wound surface. It was repeated every week for 4 weeks. Group 2: Patients received saline dressings once a week for 4 weeks. The assessment of the ulcer size was done with the help of photographs, and ulcer area was measured. Results: The mean reduction in the area of the ulcer size in PRF group was 85.51%, and the mean reduction in the area of the ulcer size in Saline group was 42.74% which was statistically significant with a P< 0.001 and t = 4.11. Conclusion: We conclude that PRF dressing can be used as it is effective, inexpensive, safe and an outpatient procedure.
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Using amniotic membrane as a novel method to reduce post-burn hypertrophic scar formation: A prospective follow-up study p. 13
Ali Akbar Mohammadi, Shima Eskandari, Hamed Ghoddusi Johari, Ata’ollah Rajabnejad
DOI:10.4103/JCAS.JCAS_109_16  
Background: Several studies have shown that the application of amniotic membrane as a biological dressing in the management of burns is accompanied by rapid re-epithelialisation. In this follow-up study, we aimed to evaluate the possible role of amniotic membrane as an adjunct to split thickness skin grafting on reducing itching and severity of hypertrophic scar formation. Materials and Methods: From October 2013 to January 2015, in a prospective follow-up study, 54 patients (108 limbs) with second and third degree burns, covering 4%–15% of total body surface area (TBSA), were included in the study. All patients needed split-thickness skin grafts for burn-wound coverage. Selected patients had symmetric burns on two (upper or lower) extremities. Then, in every patient, the extremities were randomly divided into two groups: In one limb, the skin graft was traditionally fixed with skin staples (control group) and in the other limb, the skin graft was covered with an amniotic membrane (amnion group). Therefore, in every patient, the graft was covered with an amniotic membrane in one extremity and fixed with skin staples in the other extremity. Finally, after 6 months, the degree of itching and hypertrophic scar formation was compared between the two groups. Results: The study group was composed of 108 limbs in 54 patients (27 males and 27 females) with a mean age of 23.54 % 4.9 years and burn 9.03 % 2.69% TBSA. The patients were divided into two groups: 54 limbs in amnion group and 54 limbs in control group. In 59.25% of the cases, patient had less itching in the extremity covered with amniotic membrane. Furthermore, in 64.81% of the cases, patients had less hypertrophic scar formation in the extremity covered with amniotic membrane. These differences were statistically significant (P < 0.001). Conclusions: Amniotic membrane used as an adjunct in split thickness skin grafting is a novel modality which significantly reduces scar formation and itching that can be greatly distressing to burn patients. However, still more prospective well designed studies are needed to prove it.
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A comparative study of collagen dressing versus petrolatum gauze dressing in reducing pain at the donor area p. 18
BA Ramesh, BK Jayalakshmi, J Mohan
DOI:10.4103/JCAS.JCAS_110_16  
Background: Skin graft is one of the commonly done procedures by plastic surgeons, dermato surgeons and general surgeons. Pain at the donor area is a common complaint by the patient. The skin graft donor site area is usually covered with petrolatum dressing dermatosurgeons. Aim: This study was done to compare collagen dressing with petroleum gauze dressing in control of post-operative pain on skin graft donor area. Materials and Methods: The study was done on forty patients, twenty as study group who received collagen dressing and twenty as control group who received petroleum gauze dressing. The procedure was randomly selected by permutated block size of four. The post-operative pain was assessed with numerical pain rating scale 0 to 10. Nursing staff did the recording of pain scale. The nursing staff was not aware whether patient had collagen or petroleum gauze dressing. Statistics: Statistical analysis used was independent 't'-test (two-sample test) and Levene's test. Results: Statistics proved that study group (collagen dressing) had lesser pain than control group (petroleum gauze dressing). Conclusion: The collagen sheet dressing on skin graft donor area reduces pain in post-operative period.
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Nasolabial perforator flap for one-stage reconstruction of nasal defects p. 22
Siddharth Prakash, Ritesh Panda, Vivek Kumar, Shiv Shankar Saha, Lalit Choudhary, Anurag Pandey, J Sasidhar Reddy
DOI:10.4103/0974-2077.204576  
Background: The excellent freedom of movement and range of this flap when based on a the nasolabial perforator flap have not been sufficiently explored. In this study, along with demonstrating the other key advantages of this flap over its traditional counterpart, we will endeavour to fill these lacunae in the available literature. Materials and Methods: From February 2009 to February 2012, twenty patients with nasal defects were repaired with a nasolabial perforator flap in the Department of Plastic and Cosmetic Surgery at Sir Ganga Ram Hospital, New Delhi. Of these, two patients (10%) underwent the procedure bilaterally. Thus, a total of 22 nasolabial perforator flap procedures were carried out. Prospectively, collected clinical records and data of each patient were retrospectively retrieved and reviewed to study the nasal defect and surgery done. Results: All the twenty (100%) patients had good functional and aesthetic outcome. All patients who had nasal stenosis preoperatively had very good improvement in the patency of the nasal passages, breathing and nasal blockage with complete recovery of symptoms. The patients were entirely satisfied with the functional recovery. Conclusions: The reliability and versatility of the nasolabial perforator flap exceed its recognised application in reconstruction of nasal defects and it must form a part of every plastic surgeon's armamentarium.
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Intra-individual right-left comparative study of medium depth peels in superficial nail abnormalities p. 28
Deepashree Daulatabad, Soni Nanda, Chander Grover
DOI:10.4103/0974-2077.204580  
Background: Superficial nail abnormalities include conditions which produce nail surface changes such as trachyonychia, pitting and ridging. Mostly, this is a neglected area due to the dearth of treatment options. Glycolic acid peeling has been reported to be effective in such cases. Aim: This study aims to assess the safety and efficacy of medium depth peels (70% glycolic acid versus phenol combination peel [8% phenol with 15% trichloroacetic acid]) in patients with superficial nail abnormalities. Materials and Methods: A right-left comparative study in patients with superficial nail abnormalities was done. On the right finger or toenails phenol combination peels and on the left side 70% glycolic acid was used in a predefined protocol over 12 weeks. The severity was assessed objectively by a new devised index (Nail Surface abnormality Index (NSI]). Patient's subjective perception of severity was assessed by Visual Analogue Scale (VAS), and that of the physician was assessed by Physician's Global Assessment (PGA) scores. Results: A total of 17 patients were enrolled, two dropped out and 15 patients were included in the final analysis (mean age 19.2 years, total 120 nails treated). The mean NSI score declined from 7.88 % 0.45 to 4.02 % 0.45 on the right side; and from 8.0 % 0.45 to 4.32 % 0.44 on left side, at the end of 12 weeks. The VAS declined from 6.57 % 0.26 to 3.87 % 0.33 on right side and from 6.32 % 0.28 to 3.78 % 0.32 on left side. According to PGA score, five patients showed good improvement, seven showed moderate improvement and three responded poorly. Conclusion: Both the medium depth peels were found to be safe and equally efficacious modalities for treatment of superficial nail abnormalities.
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Comparative study of efficacy and safety of botulinum toxin a injections and subcutaneous curettage in the treatment of axillary hyperhidrosis p. 33
Leelavathy Budamakuntla, Eswari Loganathan, Anju George, BN Revanth, V Sankeerth, Sacchidananda Aradhya Sarvjnamurthy
DOI:10.4103/JCAS.JCAS_104_16  
Background: Primary focal axillary hyperhidrosis is a chronic distressing disorder affecting both the sexes. When the condition is refractory to conservative management, we should go for more promising therapies like intradermal botulinum toxin A (BtxA) injections in the axilla, and surgical therapies like subcutaneous curettage of sweat glands. Aims and Objectives: The aim of this study is to compare the efficacy, safety and duration of action of intradermal BtxA injections in one axilla and subcutaneous curettage of sweat glands in the other axilla of the same patient with axillary hyperhidrosis. Materials and Methods: Twenty patients (40 axillae) received intradermal BtxA injections on the right side (20 axillae) and underwent tumescent subcutaneous curettage of sweat glands on the left side (20 axillae). Sweat production rate was measured using gravimetry analyses at baseline and at 3 months after the procedure. Subjective analyses were done using hyperhidrosis disease severity scale (HDSS) score at baseline, at 3rd and 6th month after the procedure. Results: At 3 months post-treatment, the resting sweat rate in the toxin group improved by 80.32% versus 79.79% in the subcutaneous curettage method (P = 0.21). Exercise-induced sweat rate in the toxin group improved by 88.76% versus 88.8% in the subcutaneous curettage group (P = 0.9). There was a significant difference in the HDSS score after treatment with both the modalities. There were no adverse events with BtxA treatment compared to very minor adverse events with the surgical method. Conclusion: Both intradermal BtxA injections and tumescent subcutaneous curettage of sweat glands had a significant decrease in the sweat rates with no significant difference between the two modalities. Hence, in resource poor settings where affordability of BtxA injection is a constraint, subcutaneous curettage of sweat glands can be preferred which has been found equally effective with no or minimal adverse events.
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Long-pulsed Nd: YAG laser and intense pulse light-755 nm for idiopathic facial hirsutism: A comparative study p. 40
Arpit Shrimal, Souvik Sardar, Soumyajit Roychoudhury, Somenath Sarkar
DOI:10.4103/0974-2077.204582  
Background: Hirsutism means excessive terminal hair growth in a female in male pattern distribution. Perception of hirsutism is subjective. Permanent laser hair reduction is a slow process taking many sessions and tracking of improvement parameters is tedious. Hence, a lot of confusion still exists regarding the type of laser most beneficial for treatment. Aim: The aim of this study was to compare the effectiveness and safety profile of long-pulsed Nd: YAG laser (1064 nm) and intense pulse light (IPL)-755 nm in management of idiopathic facial hirsutism. Settings and Design: Open-labelled, randomly allocated experimental study. Subjects and Methods: The study included 33 cases of idiopathic facial hirsutism. Patients were randomly divided into Group A, treated with long-pulsed Nd: YAG laser and Group B, treated with IPL-755 for a total of six sessions at 1 month interval. Statistical Analysis: Chi-square test was used in Medcalc® version 9.0 and the test of significance was taken to be P< 0.05. Results: Average percentage of improvement in Group A, according to patients at each sessions were 46.33%, 70.66%, 81.66%, 84.67%, 85.33%, 87.33% and that in Group B were 28.06%, 39.72%, 52.22%, 64.72%, 67.78%, 71.11%, respectively. Excellent response (>75% reduction in hair) after six sessions in Group A was seen in fourteen (93.33%) out of fifteen patients, whereas in Group B, it was seen only in three (16.66%) out of eighteen patients. In Group A, erythema was seen in 26.67%, perifollicular edema and hyperpigmentation in 13.33% each. In Group B, erythema was seen in 50% patients, perifollicular edema in 16.67% and hyperpigmentation in 38.89% patients. Conclusions: Long-pulsed Nd: YAG Laser (1064 nm) is better than IPL-755 nm in terms of safety and effectiveness in the management of idiopathic facial hirsutism.
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VIEWPOINT Top

Should advertising by aesthetic surgeons be permitted? Highly accessed article p. 45
Neeraj Nagpal
DOI:10.4103/JCAS.JCAS_77_16  
Cosmetic, aesthetic and cutaneous surgical procedures require qualified specialists trained in the various procedures and competent to handle complications. However, it also requires huge investments in terms of infrastructure, trained staff and equipment. To be viable advertising is essential to any establishment which provides cosmetic and aesthetic procedures. Business men with deep pockets establish beauty chains which also provide these services and advertise heavily to sway public opinion in their favour. However, these saloons and spas lack basic medical facilities in terms of staff or equipment to handle any complication or medical emergency. To have a level playing field ethical advertising should be permitted to qualified aesthetic surgeons as is permitted in the US and UK by their respective organisations.
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COMMENTARY Top

Should advertising by aesthetic surgeons be permitted? p. 48
Venkataram Mysore
DOI:10.4103/JCAS.JCAS_39_17  
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INNOVATIONS Top

Spring-loaded syringe for multiple rapid injections p. 49
CR Srinivas, Anirudh Somani, CK Shashidharan Nair, Thirumurthy Mylswamy
DOI:10.4103/0974-2077.204584  
Mesotherapy refers to multiple injections of small quantity of the drug over a large area. The mesoguns available are expensive and the motor-driven models tends to waste the expensive material to be injected since the plunger stops after injecting without recoil. We searched for a less expensive device which would inject like the mesogun and still not waste the solution. On searching the web, we identified a spring-loaded syringe. We describe the assembly and use of this inexpensive syringe for delivering multiple injections with minimal wastage.
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CASE REPORT Top

Plaque like giant dermatofibroma: A case report p. 51
Vinitha Varghese Panicker, Andezhuthu Divakaran Dharmaratnam, NV Seethalekshmy
DOI:10.4103/JCAS.JCAS_117_16  
Dermatofibroma, also known as benign fibrous histiocytoma, is a soft-tissue tumour that usually occurs in the mid-adult life and shows a slight female predominance. Giant dermatofibroma, a very rare clinical variant, is characterised by its unusually large size, benign biological behaviour despite its large size and same histopathological characteristics as conventional dermatofibroma. We report a 63-year-old woman who presented with a large tumour on the scapular region which showed histopathological features of benign dermatofibroma.
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CORRESPONDENCE Top

Reconstruction with dorsal nasal flap after excision of basal cell carcinoma of the nose p. 54
Amitabh Jena, Revanth Gangasani, Naru Ramana Reddy, Rashmi Patnayak
DOI:10.4103/JCAS.JCAS_128_15  
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Nasal ala reconstruction: Surgical conundrum p. 55
Ana Ortins-Pina, Ana Isabel Teixeira, Maria Sanches, Ana Isabel Gouveia, Paulo Leal Filipe, João Maia Silva
DOI:10.4103/JCAS.JCAS_130_16  
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Squamous cell carcinoma of the nail bed: The great mimicker p. 59
Swagata Arvind Tambe, Priyanka Deelip Patil, Dattatray Govind Saple, Ulhas Yashwant Kulkarni
DOI:10.4103/JCAS.JCAS_35_16  
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Successful management of dowling-degos disease with combination of Q-switched Nd: YAG and fractional carbon dioxide laser p. 60
Swagata Arvind Tambe, Priyanka Deelip Patil, Dattatray Gopal Saple
DOI:10.4103/0974-2077.204583  
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ERRATUM Top

Erratum: Recurrent adult nasal dermoid cyst p. 63

DOI:10.4103/0974-2077.204585  
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