Journal of Cutaneous and Aesthetic Surgery
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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 13 | Issue 1
Page Nos. 1-75

Online since Thursday, March 19, 2020

Accessed 1,978 times.

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REVIEW ARTICLE  

Facial blanching after local anesthesia injection: Clinico-anatomical correlation—Review of literature p. 1
Amin Rahpeyma, Saeedeh Khajehahmadi
DOI:10.4103/JCAS.JCAS_137_19  
Facial blanching as a complication of local anesthesia is reported in dentistry. Inadvertent arterial penetration and subsequent vasospasm has been accepted as the mechanism of this phenomenon. Most cases occur after inferior alveolar nerve block injection. In this article, five cases are reported after Gow-Gates injection, maxillary nerve block via greater palatine foramen, inferior alveolar nerve block, and maxillary buccal infiltration. It is the largest case series in this topic. Also, clinico-anatomical correlation between facial–mucosal blanching and the site of intra-arterial injection is explained. To the best of our knowledge, partial blanching of the face subsequent to buccal infiltration is reported for the first time in this article. Cutaneous surgeon should be aware of this complication and should not carry out unnecessary treatment.
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ORIGINAL ARTICLES Top

A comparative study of elongation of earlobe following two different modalities for repair of posttraumatic split of earlobe: Simple side-to-side closure and closure with anterior posterior flap modification p. 5
Ruchi Hemdani, Manas Chatterjee, Keshav Markanday
DOI:10.4103/JCAS.JCAS_92_19  
Context: Ear piercing is a common practice in women seen in the Asian and African subcontinents. Traumatic elongation of ear lobe cleft is seen following long-standing use of heavy jewellery on the ear, or a tug on the earring. These inadvertent tears of the lobe have resulted in patients seeking earlobe repairs, which are routinely performed as an outpatient procedure. Various surgical methods exist for earlobe repair from the simple closure to modified flaps and Z-plasty. Certain methods with excessive tissue loss can result in elongation of the earlobe postprocedure. Aims and Objectives: This study aimed to compare the elongation of earlobe post repair with simple side-to-side closure versus closure with anterior–posterior flap modification. Settings and Design: A cohort study conducted at the outpatient department in a tertiary care hospital of Mumbai. Materials and Methods: A total of 30 women with bilateral, equal, or almost equal earlobe clefts were enrolled in this study. After informed consent, simple side-to-side closure was performed on one earlobe and closure with anterior–posterior flap modification was carried out on the other side in the same patient under strict aseptic precautions. Patients were followed up two weekly till 12 weeks postoperative for any possible elongation of earlobe. Statistical Analysis Used: The data were analyzed using Statistical Package for the Social Sciences (SPSS, IBM, New York, USA) software package for windows, version 20.0. Quantitative and qualitative variables were presented as mean ±standard deviation (SD) and as frequency with percentages. The comparison was done with paired t-test. Results: It was seen that earlobe repairs led to significant elongation of the lobe with simple closure, which did not occur with flap modification irrespective of cleft sizes. Conclusion: It is imperative to choose a correct method to avoid postprocedure elongation of earlobe.
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A comparative study to assess the efficacy of fractional carbon dioxide laser and combination of fractional carbon dioxide laser with topical autologous platelet-rich plasma in post-acne atrophic scars Highly accessed article p. 11
Nazneen Z Arsiwala, Arun C Inamadar, Keshavmurthy A Adya
DOI:10.4103/JCAS.JCAS_142_19  
Context: Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit prevalent in adolescent population. Atrophic acne scarring negatively affects the quality of life. Although challenging to treat, the introduction of fractional carbon dioxide (CO2) laser and platelet-rich plasma (PRP) therapy for atrophic scars has opened up new avenues. Aim: The aim of this study was to evaluate and compare the efficacy of fractional CO2 laser alone and in combination with topical PRP in treating post-acne atrophic scars. Subjects and Methods: A hospital-based prospective, double-blinded, randomized, and comparative study was conducted. A total of 33 cases with post-acne atrophic scars of moderate to severe grade were randomly allotted into Group A and Group B who were treated for three monthly sessions of fractional CO2 laser followed by topical PRP and fractional CO2 laser monotherapy, respectively. Evaluation at baseline and every visit was carried out and compared at the end of 12 weeks. Results: Of the 33 patients, 25 completed the study. The mean change in score was higher in subjects of Group A. The mean scar score significantly reduced in both groups. The mean visual analog scale was higher in Group A. The reduction in scar score was significantly higher in patients with rolling scars and boxcar scars and least in ice pick scars. Erythema, edema, pain, and hyperpigmentation were higher in Group B. Conclusion: Combination therapy with PRP is more efficacious in reducing post-acne atrophic scars and reducing adverse effects of laser therapy as compared to fractional CO2 laser monotherapy.
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Efficacy of topical timolol versus saline in chronic venous ulcers: A randomized controlled trial p. 18
Abhay K Rai, K Janani, Reena Rai
DOI:10.4103/JCAS.JCAS_13_19  
Background: Chronic venous ulcers sometimes fail to heal in spite of adequate treatment. Nonhealing is possibly because of chronic activation of β-2 adrenergic receptor (B2-AR) in the keratinocytes by endogenously generated catecholamines, which inhibits keratinocyte migration. Blocking of B2-AR using β-blockers has been reported to promote wound healing through keratinocyte migration, angiogenesis, and fibroblast migration. Topical timolol, a B2-AR antagonist, is used to promote wound healing. Aims and Objectives: The aim of this study was to compare the efficacy of topical timolol versus saline in chronic venous leg ulcers and to compare the mean reduction in ulcer area at the end of 4 weeks. Materials and Methods: Twenty patients were randomized into two groups. Patients in Group 1 were treated with one drop of 0.5% topical timolol every alternate days for 4 weeks. Ulcer margins were measured and ulcer area calculated every week for 4 weeks. Similar dressing and measurement were carried out for patients with saline for 4 weeks. Healing rate was assessed by the percentage of reduction of ulcer area of both groups at week 4. Results: The mean reduction in the ulcer size in timolol group was 86.80%, and in saline group 43.82% at the end of 4 weeks. Conclusion: Topical timolol is an easy, noninvasive therapy that can be recommended for chronic ulcer.
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The effectiveness of cutaneous wart resolution with current treatment modalities p. 24
Sarah A Ringin
DOI:10.4103/JCAS.JCAS_62_19  
Non-venereal warts are a frequent dermatological presentation with potential spontaneous regression in immunocompetent adults and children within 2 years. Evidence shows that conventional wart treatments are not a guaranteed treatment modality and can carry concerns regarding safety. The aim of this literature review was to identify the most effective treatments for wart resolution to guide clinical practice while identifying areas for further research.A systematic literature review was performed to determine the current treatment modalities for non-anogenital cutaneous warts in immunocompetent individuals and their effectiveness. Articles were categorized into one of eight groups depending on anatomical location, population age, or recalcitrant status with ranked levels of evidence.This literature review highlights a variety of treatments for non-venereal warts shown to be effective. In this instance where optimal evidence-based treatments are not available, clinical experience determines the most appropriate clinical practice.Further reproducible immunotherapy research on wart resolution is required to enable clear comparisons of these treatment modalities to conventional methods. Future clinical practice will require the human papillomavirus type to target the wart treatment accordingly; however, further research is required to determine these correlations.
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CASE REPORTS Top

Donor area acute effluvium following follicular unit extraction—trichoscopic simulator of alopecia areata: Series of four cases Highly accessed article p. 31
Amit S Kerure, Sandip M Agrawal, Rachita Dhurat, Alex Ginzburg
DOI:10.4103/JCAS.JCAS_77_19  
Follicular unit extraction (FUE) is a popular hair transplant technique, which involves extraction of follicular grafts from the donor area, usually occipital area of scalp. We have described few cases where non-scarring alopecia patches appeared at donor area similar to that of alopecia areata clinically, after 2–3 weeks of surgery. Even trichoscopically, findings were similar to alopecia areata showing exclamation marks, black dots. However, on histopathology, there were dilated blood vessels, mucin deposition, and only few lymphocytes, which mimic histopathology of healing wound. We hypothesize that compromised blood supply and trauma to the existing hairs after harvesting can lead to post-hair transplant effluvium, which is probably due to anagen effluvium.
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CASE REPORT Top

Full-thickness pediatric burn following reaction between cyanoacrylate nail adhesive and cotton shirt p. 35
Eric Clayman, Alicia Billington, Carl Wayne Cruse
DOI:10.4103/JCAS.JCAS_64_19  
Cyanoacrylate is an acrylic resin that is used as an adhesive in acrylic nail glues and various other strong, rapidly acting adhesives, such as “Dermabond” and “Super Glue.” This adhesive is very effective in a variety of settings; however, when cyanoacrylate comes into contact with cotton fibers, an exothermic reaction occurs that is severe enough to cause a full-thickness burn to the underlying skin. Full-thickness burns requiring excision and skin grafting can be psychologically devastating for patients, especially the pediatric population and their parents, who may believe they are to blame for their child’s burn. We present the case of a 2-year-old boy who developed a full-thickness burn after spilling acrylic nail glue onto his cotton shirt. Fortunately, his burn was small enough that excision with primary closure was able to be performed. However, he unfortunately developed hypertrophic scarring postoperatively. Owing to the widespread use of cyanoacrylate adhesives in the general population, it is important to spread awareness of the potential dangers associated with these adhesives to prevent potential physical and psychological injuries related to improper use of these adhesives.
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INNOVATIONS Top

Autologous smashed follicular dermal graft with epidermal cell suspension in chronic nonhealing leg ulcers p. 38
Umashankar Nagaraju, Pranami Kashyap, Leena Raveendra
DOI:10.4103/JCAS.JCAS_105_19  
Wound healing is a multifaceted process. Restoration of the epithelium may occur either by migration of activated epithelial keratinocytes from the adjoining epithelium or by centrifugal migration of putative stem cells found in the bulge region of the hair follicle. Dermal collagen and glycosaminoglycans also play a key role in laying down the scaffold for vascular in-growth and population of the matrix with host fibroblasts. Despite the availability of a wide range of treatment modalities, chronic nonhealing leg ulcers remain a therapeutic challenge and cause significant patient morbidity. Hence, there is a further need to develop novel techniques which would be effective, safe, easily available, and affordable for the patient.
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Using hypodermic needle as suture needle in emergency p. 43
Sanjeev Gupta, Ravi S Jangra, Saurabh S Gupta, Sunita Gupta
DOI:10.4103/JCAS.JCAS_144_19  
Sometimes, suture thread detaches from needle while suturing. This leads to wastage of left over thread and we have to repeat whole process of suturing as the extra suture needles are not easily available. The present article highlights the use of hypodermic needle as suture needle in such emergencies.
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SHORT COMMUNICATIONS Top

17th national conference of association of cutaneous surgeons (I) (ACSICON 2019)––conference report p. 46
Chander Grover, Somesh Gupta, Vineet Relhan, Rajinder Parshad Gupta
DOI:10.4103/JCAS.JCAS_91_19  
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A histological and clinical evaluation of plasma as a graft-holding solution and its efficacy in terms of hair growth and graft survival p. 50
Anil K Garg, Seema Garg
DOI:10.4103/JCAS.JCAS_97_19  
Background: There is a time lag between hair follicle harvesting and implantation; during this time, hair follicles have ischemic injury. We need a holding media or a solution to minimize or neutralize ischemic injury. Aim and Objectives: The aim of this study was to evaluate plasma as a graft-holding solution in terms of its efficacy in hair growth and hair graft survival. Materials and Methods: A split-scalp study was carried out. The left side was designated as the control area (Group A), where graft implanted was kept in Ringer's lactate (RL), and the right side behaved as the test area (Group B), which received grafts preserved in autologous plasma. The P value was calculated. Observations: MTT [3-(4,5-Dimethylthiazol-2-Yl)-2,5-Diphenyltetrazolium Bromide] staining for graft stored in RL at 12–72 h showed poor hair follicles cells survival, whereas graft kept in plasma showed viable cells even after 72h. The hair count and density in plasma group were significantly higher than the RL group. There was an improvement in hair thickness in both groups from 6 to 12 months. Conclusion: Autologous plasma is an easily available graft-holding solution. Platelets along with the plasma provide multiple growth factors promoting epithelialization, neovascularization, and action on hair follicle stem cells to improve growth. The fibrin coating around graft makes it sticky and prevents dehydration. The split-scalp controlled study certainly shows the advantages of using plasma over other extracellular graft-holding solutions.
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SHORT COMMUNICATION Top

External knot for running intradermal stitch p. 57
Garrison A Leach, Hally M Chaffin, Meghan C Bristyan, Travis C Holcombe
DOI:10.4103/JCAS.JCAS_83_19  
We describe a unique method for closure of running subcuticular/intradermal suture that minimizes potential abscess formation and maximizes cosmetic outcomes.
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PRACTICE POINTS Top

Hand glove: A tool not used to its potential p. 59
Avitus J Prasad, Animesh Saxena, Vivek K Dey
DOI:10.4103/JCAS.JCAS_59_19  
A hand glove is not only used to maintain sterility of the procedure but also to protect the physician from communicable diseases. A glove can be used in a variety of procedures, which are commonly performed in clinics. These help the doctor by serving as a tool in procedures and in cutting the cost of these procedures. A hand glove could be used in various innovative ways as highlighted in this article.
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COMMENTARIES Top

28th Turkish National Dermatology Congress, September 24–28, 2019, Antalya, Turkey p. 62
Robert A Schwartz
DOI:10.4103/JCAS.JCAS_157_19  
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Third combined south african congress of the dermatology, dermatologic surgery, and vitiligo societies, pretoria, Republic of South Africa p. 66
Robert A Schwartz, Imran Majid
DOI:10.4103/JCAS.JCAS_156_19  
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CORRESPONDENCES Top

Plaque-type cutaneous sclerosis: A late complication of filler injection? p. 70
Jose M Neves, Alexandre João, Joana Cabete
DOI:10.4103/JCAS.JCAS_114_19  
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Venolymphatic malformation of the tongue and response to sclerotherapy using sodium tetradecyl sulfate p. 73
Archana Singal, Suchi Bhatt
DOI:10.4103/JCAS.JCAS_70_19  
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