Journal of Cutaneous and Aesthetic Surgery
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   Table of Contents - Current issue
Coverpage
October-December 2016
Volume 9 | Issue 4
Page Nos. 213-289

Online since Thursday, December 29, 2016

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EDITORIAL  

Crossing surgical borders: Where are we, where are we going and can we find the way? p. 213
Niti Khunger
DOI:10.4103/0974-2077.197027  PMID:28163449
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REVIEW ARTICLE Top

Cooling devices in laser therapy p. 215
Anupam Das, Aarti Sarda, Abhishek De
DOI:10.4103/0974-2077.197028  PMID:28163450
Cooling devices and methods are now integrated into most laser systems, with a view to protecting the epidermis, reducing pain and erythema and improving the efficacy of laser. On the basis of method employed, it can be divided into contact cooling and non-contact cooling. With respect to timing of irradiation of laser, the nomenclatures include pre-cooling, parallel cooling and post-cooling. The choice of the cooling device is dictated by the laser device, the physician's personal choice with respect to user-friendliness, comfort of the patient, the price and maintenance costs of the device. We hereby briefly review the various techniques of cooling, employed in laser practice.
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ORIGINAL ARTICLES Top

Overview of local flaps of the face for reconstruction of cutaneous malignancies: Single institutional experience of seventy cases p. 220
Jagdeep K Rao, Kaustubh Sharad Shende
DOI:10.4103/0974-2077.197029  PMID:28163451
Context: The most common malignant tumours of the face are basal cell carcinoma, squamous cell carcinoma and melanoma. While the results of skin graft are less than satisfactory for large areas to cover, distant flaps are bulky with a poor colour match. Local fasciocutaneous flaps provide reasonable option for reconstruction of facial defects with good colour and texture match and good success rate. Aims: This study aimed to analyse the various modalities of reconstruction after resection of facial malignancies and their advantages and disadvantages. Settings and Design: This was a retrospective study. Materials and Methods: Of 70 patients, 34 were managed with V-Y advancement flap, 24 with nasolabial flap, 8 with median forehead flap and 4 with standard forehead flap cover. The duration of follow-up ranged from 6 months to 2 years. Statistical Analysis Used: Nil. Results: Of 34 V-Y advancement flaps, 2 showed suture dehiscence at the apex of triangle which was allowed to heal secondarily with regular dressings. All the 24 nasolabial flaps were healthy without any complication. All patients had satisfactory functional and cosmetic outcomes. Conclusions: In our experience, local flaps give the best results and are the first choice for reconstruction of the face. Most defects can be best closed by nasolabial, V-Y advancement and forehead flap. Outstanding functional and cosmetic results can be achieved. Proper execution requires considerable technical skill and experience.
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Outcome of flap surgeries in dermatosurgical unit at a tertiary care centre in India with a review of literature p. 226
Gorur Kalappa Divya, Kanathur Shilpa, Sacchidanand Sarvajnamurthy, Eswari Loganathan, Biju Vasudevan, GB Chitrika, C Madhura, DV Lakshmi
DOI:10.4103/0974-2077.197044  PMID:28163452
Introduction: Flap surgeries are an excellent choice for closing large defects following trauma, excision of carcinomas or removal of large lesions. This article is a prospective interventional study of various flap surgeries performed at a tertiary care centre with their outcome in dermatosurgical unit. Materials and Methods: A total of 35 flap surgeries performed from January 2012 to December 2014 formed part of the study. Data were recorded for each case including age, sex, indications and type of flap surgery and any occurrence of complications. Results: Out of the 35 patients, basal cell carcinoma was the most common indication for surgery in 22 patients, followed by Bowen's disease in five, dermatofibroma in three and porocarcinoma in two. Other indications were squamous cell carcinoma, tuberous xanthoma, myxoid cyst and nevus sebaceous. Rhomboid flap and rotaion flap were done in 12 patients each, V-Y plasty in three patients, advancement flap, crescentic advancement flap and O-Z plasty were done in two patients each, O-Z plasty was done in two patients, A-T plasty and H plasty were done in one patient each. Common complications observed were flap necrosis seen in three patients and one patient developed hematoma on the second post-operative day, hypertrophic scar in one case and recurrence of BCC. Conclusion: Malignant and pre-malignant lesions were common indications in our study. Excellent outcome of flap surgeries promises to be a birdie stroke in the armamentarium of dermatosurgeons.
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Reduction of blister formation time in suction blister epidermal grafting in vitiligo patients using a household hair dryer p. 232
Shweta Arora, Bikash Ranjan Kar
DOI:10.4103/0974-2077.197045  PMID:28163453
Background: Suction blister epidermal grafting (SBEG) is a simple and effective way of surgical repigmentation in vitiligo. The major problem faced is the time taken for the formation of blisters. Temperature at the suction site is one of the factors affecting the blister formation time. Aims and Objectives: To reduce the blister formation time in SBEG by increasing the surface temperature to 44°C. Materials and Methods: This is a left-right comparison study. Total seven patients with lip vitiligo involving both the angles of lips were enrolled. Suction syringes were applied on both the thighs of all the patients. On the right thigh, blisters were raised as per the procedure standardised by Gupta et al. On the left thigh, similar procedure was used, but a hair dryer was used additionally to increase the surface temperature of the skin to 44°C. The time taken for the formation of well-formed, dome-shaped, unilocular blister was noted. Results: The mean time taken for the formation of blister on the right thigh was 121.1 ± 6.2 min and on the left thigh was 69.6 ± 5.4 min. All the seven patients were started on PUVASOL after SBEG. There was complete repigmentation of the grafted sites in all the patients after 2 months. Conclusion: Hair dryer is easily available, affordable and simple to use and the time saved during the procedure is quite significant.
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Comparative study to evaluate the efficacy of radiofrequency ablation versus trichloroacetic acid in the treatment of xanthelasma palpebrarum p. 236
Praveen Kumar Shanmugam Reddy, Sumathy Tharayil Kunneth, Shyam Prasad Arakali Lakshminarayana, Suparna Madivalara Yallappa, Ranganathan Chandrashekara, Shivaswamy Kanakapura Nanjundaswamy
DOI:10.4103/0974-2077.197073  PMID:28163454
Background: Xanthelasma palpebrarum (XP) is a metabolic disorder involving the eyelids. Radiofrequency(RF) surgery and trichloroacetic acid (TCA) applications have been listed among the procedures for XP, but comparative studies are not available. Aim: To compare the efficacy of radiofrequency surgery versus trichloroacetic acid application in the treatment of XP. Settings and Design: 20 consecutive cases of XP attending dermatology, medicine and endocrinology out-patient departments of M.S.Ramaiah teaching hospital were enrolled for the study. It was an open-label clinical trial conducted in our hospital for a duration of 1 year. Materials and Methods: 20 consecutive patients conforming to inclusion criteria were selected for the study. For each patient, lesions were treated with radiofrequency ablation on one side and TCA application on the other side. Results: RF ablation was done for 12 patients over right eye lesions and 8 patients over the left eye lesions. TCA applications were done for 8 patients over right eye lesions and 12 patients over left eye lesions. 70% of lesions treated with RF ablation had a score of improvement of 4 and 70% of lesions treated with TCA application had a score of improvement of 4, at 4 weeks of follow-up. At four weeks of follow-up 40% in RF group and 15% in TCA group had scarring and 45% in RF group and 30% in TCA group had pigmentation. Conclusion: RF ablation as compared to TCA application, required fewer sessions for achieving more than 75% clearance of lesions. However, TCA applications were associated with fewer complications comparatively.
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Papular acne scars of the nose and chin: An under-recognised variant of acne scarring p. 241
Faisal R Ali, Michael Kirk, Vishal Madan
DOI:10.4103/0974-2077.197075  PMID:28163455
Background: Scarring following acne vulgaris is common and can be of profound psychosocial consequence. Aims and Objectives: We have clinically noted a variant of acne scarring, overlooked by previous categorisation schemes, which we have denominated as papular acne scars of the nose and chin. We sought to characterise these novel entities further. Materials and Methods: Initially, we identified 14 patients with papular acne scars of the nose and chin in a cosmetic dermatology clinic, of whom two were female and rest were male. We then prospectively evaluated 100 consecutive patients attending our tertiary referral acne isotretinoin clinic and 49 patients attending a general dermatology clinic. Results: Amongst 149 patients, from a general dermatology and tertiary acne clinic, soft papular scars were noted in four patients, distributed on the nose and chin. Three of the four patients were male, three patients had additional acne scars and the median age was 23.5. Conclusions: We have identified 18 patients with papular acne scars of the nose and chin and propose that this new category should be added to acne scarring classification schemes. Future work should be directed at corroborating the epidemiology of such lesions and describing effective treatment modalities.
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Outcome of dermal grafting in the management of atrophic facial scars p. 244
Kanathur Shilpa, S Sacchidanand, Budamakuntla Leelavathy, Padmanabha Shilpashree, Gorur Divya, Rammurthy Ranjitha, DV Lakshmi
DOI:10.4103/0974-2077.197077  PMID:28163456
Background: Scars over the face are cosmetically and psychologically disturbing. Various techniques have been described and are being practiced in the management of these scars. Aims and Objectives: This study was undertaken to study the safety, effectiveness of using dermal grafts as fillers in the management of facial scars due to acne, chickenpox, trauma or any others. Materials and Methods: Fifteen patients with atrophic facial scars of varied aetiology and willing for surgery were considered for dermal graft technique. After pre-operative workup, subcision was done 2 weeks before planned surgery. Depending on the type of scar, grafts were inserted using pocket or road railing techniques. Scar improvement was assessed based on patient satisfaction. Results: Linear scars showed excellent improvement. Acne, varicella and traumatic scars also showed good improvement. However, two patients did not appreciate improvement due to marked surface irregularities as the scars were elevated. They were further subjected to LASER and chemical peel resurfacing. Conclusion: Dermal grafting can be used in the management of any round to oval facial scar which is soft, prominent and at least 4-5 mm across; linear scars at least 2-3 mm across and 3-4 cm in length. However, scars with prominent surface irregularities need further resurfacing techniques along with dermal grafting. Limitations: Limitations of the study include small sample size, and only subjective assessment of the scar has been taken into consideration to assess the outcome.
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Near infrared pulsed light for permanent hair reduction in Fitzpatrick skin types IV and V p. 249
Pratik Thacker, Pramod Kumar
DOI:10.4103/0974-2077.197078  PMID:28163457
Background: Excessive hair on the face is a significant cause for distress amongst women. Permanent hair reduction methods including lasers and pulsed light devices are increasingly being used. Aims: The aim of this study is to evaluate the efficacy and safety of near infrared pulsed light source for permanent hair reduction in women seeking treatment for excessive hair growth on the upper lip and chin. Settings and Design: This was a prospective observational study done at a tertiary care hospital in South India. Materials and Methods: Women above 18 years of age were observed for six sittings of the treatment for excessive hair over the upper lip and chin using a near infrared intense pulsed light device. Efficacy was evaluated by measuring percentage hair reduction using digital photography. Further, efficacy amongst women with polycystic ovarian syndrome (PCOS) was compared with those without PCOS. Side effects were noted. Statistical Analysis Used: Student's unpaired t-test using the software SPSS version 16. Results: Percentage hair reduction at the end of 6 sittings in 24 women for the upper lip and chin was 52.87% and 73.81%, respectively. Out of the 24 women, 12 had PCOS and the difference in hair reduction in these women was statistically insignificant when compared to that observed in those without PCOS. Only two patients experienced side effects in the form of mild pain and discomfort. Conclusions: Intense pulsed light is a safe and efficacious tool for permanent hair reduction over the upper lip and chin, efficacy being similar in patients with or without PCOS.
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PRACTICE POINTS Top

Nail photography: Tips and tricks p. 254
Feroze Kaliyadan, KT Ashique
DOI:10.4103/0974-2077.197080  PMID:28163458
Photographic documentation of the nails is important in the objective evaluation of response to treatment and in disseminating scientific information related to nail diseases. The key to a good image of the nail is proper framing and achieving a sharp focused image with good contrast with the background, at the same time avoiding strong reflections from the nail surface. While the general principles of clinical photography apply to nail imaging also, this article attempts to highlight some tips which can be specifically used to improve the quality of nail images.
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INNOVATION Top

Autologous smashed dermal graft with epidermal re-closure: Modified technique for acne scars p. 258
Umashankar Nagaraju, Mahesh K Chikkaiah, Belliappa P Raju, Priyanka Agarwal
DOI:10.4103/0974-2077.197081  PMID:28163459
Conventional technique of dermal grafting for acne scars where the source of filler material used is the patient's own dermis requires longer surgical time, recovery period and can result in unsightly scars at the donor area. Hence, it is not suitable for treating a larger number of scars. Furthermore, these dermal grafts are firm and cannot be contoured to fit all types of acne scars. Occurrence of epidermal cyst and secondary infection is another complication if epidermis is not completely removed. Enzymatic techniques need trypsinisation which is expensive and requires laboratory facilities.
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Diode laser ear piercing: A novel technique p. 263
Bibilash Babu Suseela, Preethitha Babu, Ravi Kumar Chittoria, Devi Prasad Mohapatra
DOI:10.4103/0974-2077.197082  PMID:28163460
Earlobe piercing is a common office room procedure done by a plastic surgeon. Various methods of ear piercing have been described. In this article, we describe a novel method of laser ear piercing using the diode laser. An 18-year-old female patient underwent an ear piercing using a diode laser with a power of 2.0 W in continuous mode after topical local anaesthetic and pre-cooling. The diode laser was fast, safe, easy to use and highly effective way of ear piercing. The advantages we noticed while using the diode laser over conventional methods were more precision, minimal trauma with less chances of hypertrophy and keloids, no bleeding with coagulation effect of laser, less time taken compared to conventional method and less chance of infection due to thermal heat effect of laser.
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CASE REPORTS Top

Familial disseminated cutaneous glomuvenous malformation: Treatment with polidocanol sclerotherapy p. 266
Aditi Jha, Niti Khunger, K Malarvizhi, V Ramesh, Avninder Singh
DOI:10.4103/0974-2077.197083  PMID:28163461
Glomuvenous malformations (GVMs) present as asymptomatic multiple pink-to-blue nodules or plaques. Disseminated lesions are rare, representing 10% of all the cases. Familial cases are caused by mutations in the glomulin gene. A young male presented with multiple bluish-to-dusky red-coloured nodules 10-15 in numbers over the trunk, limbs and buttocks since 12 years of age. They ranged in size from 1 to 3 cm, partially to non-compressible and tender on palpation. There was no history of any systemic complaint. His sister and mother had similar lesions but in a limited distribution. Biopsy showed multiple ectatic dilated vascular channels lined by multiple layers of glomus cells consistent with the diagnosis of GVM. The biopsy of the lesions from the mother and sister also showed similar features. Mutation analysis for glomulin gene could not be done because of the unavailability of the facility at our setting. He underwent sclerotherapy with 3% polidocanol every 2 weeks, and there was significant improvement in the lesions after six sessions of sclerotherapy. The patient is under follow-up and there is no recurrence of the lesions over treated sites after 6 months.
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Onychomatricoma: A case report with 5-year follow-up p. 270
Cleide Eiko Ishida, Bruna Melhoranse Gouveia, Tullia Cuzzi, Marcia Ramos-e-Silva
DOI:10.4103/0974-2077.197084  PMID:28163462
The authors present a case of onychomatricoma, a rare benign tumour of the nail matrix, first described by Baran and Kint in 1992. The lesion appeared on the proximal nail fold, covering half the nail of the second left finger. The nail was thickened and yellowish with longitudinal melanonychia. It was surgically removed with very satisfactory aesthetic results even after 5 years. A review on the subject is also presented.
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VIEWPOINT Top

It is the cooperation, stupid! p. 274
Somesh Gupta
DOI:10.4103/0974-2077.197085  PMID:28163463
The rise of aesthetics in medicine has resulted from society's acknowledgement of the importance of physical beauty. This has led to an emerging conflict between allied specialties. The author introduces the concept of "Aesthetic Socialism" according to which everyone should have an opportunity to enhance or restore the beauty where it is missing or when it is lost due to disease, trauma or ageing. However, there are multiple aspects of aesthetics, which can not be addressed by a single specialty, therefore author recommends interdisciplinary cooperation rather than conflict to achieve aesthetic socialism.
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CORRESPONDENCE Top

O to Z local skin flap: The role for managing depressed facial scar after resolution of odontogenic source of infection p. 278
Amin Rahpeyma, Saeedeh Khajehahmadi
DOI:10.4103/0974-2077.197086  PMID:28163464
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Utility of laser in lobuloplasty p. 279
Sandhya Pandey, Ravi Kumar Chittoria, Elan Kumar, Devi Prasad Mohapatra, MT Friji, Dinesh Kumar Sivakumar
DOI:10.4103/0974-2077.197087  PMID:28163465
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Angiolymphoid hyperplasia with oeosinophilia showing promising result with intralesional radio-frequency ablation therapy: A new cost-effective and hassle-free modality of treatment p. 281
Chintaginjala Aruna, Senthil Kumar Alagappan, Ramamurthy Damaraju Venkata Satya Bhaskara, Sruthi Kondaveeti
DOI:10.4103/0974-2077.197088  PMID:28163466
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A linear fleshy corrugated plaque on the right vulva: A diagnostic surprise p. 283
Aditya Kumar Bubna, Poojitha Pedarla
DOI:10.4103/0974-2077.197089  PMID:28163467
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Use of dermatoscope to monitor the repigmentation of various vitiligo surgical procedures p. 286
Balakrishnan Nirmal
DOI:10.4103/0974-2077.197090  PMID:28163468
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Unusual site for cystic hygroma: A single centre experience p. 287
Sandeep K Rahul, Basant Kumar, Ankur Bhatnagar, Eti Sthapak, Vijai D Upadhyaya
DOI:10.4103/0974-2077.197091  PMID:28163469
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