FROM THE LITERATURE
Year : 2009 | Volume
: 2 | Issue : 1 | Page : 51--52
From the Literature
Rabindra Kumar Yadav
Trainee Dermatologist, Venkat Charmalaya Centre for Advanced Dermatology, Bangalore, India
Rabindra Kumar Yadav
Trainee Dermatologist, Venkat Charmalaya Centre for Advanced Dermatology, Bangalore
|How to cite this article:|
Yadav RK. From the Literature.J Cutan Aesthet Surg 2009;2:51-52
|How to cite this URL:|
Yadav RK. From the Literature. J Cutan Aesthet Surg [serial online] 2009 [cited 2020 Sep 24 ];2:51-52
Available from: http://www.jcasonline.com/text.asp?2009/2/1/51/53106
A Simple Therapeutic Strategy with Super Elastic Wire for Ingrown Toenails
Moriue T, Yoneda K, Moriue J, Matsuoka Y, Nakai K, Yokoi I, et al .
Dermatologic Surgery 2008;34:1729-32
A painful ingrown toenail is one of the most common diseases of toenails. Surgical procedures like total/ partial excision of the nail bed, phenolization, and CO 2 laser matricectomy are commonly performed with disadvantages like complexity, pain, time consumption, need for local anesthesia, cosmetic deformity and recurrences.
A new therapy for ingrown nails by using super elastic wire (SE-wire) is described. SE wire is an alloy of nickel and titanium available as Machiwire (Tama Medical Corp., Tokyo, Japan). Two holes are made with 23-G needles at the distal free edge of the nail plate in the white portion. SE wire is inserted through the holes until the degree of the nail plate becomes less than 60° by restoration power. Wire loop is then pushed downwards with pliers and wire bent forwards and cut with clippers, so that it doesn't protrude from nail end. Hole is then filled with surgical glue (ethyl 2-cyanoacrylate adhesive agent). The elasticity of the wire helps in curing the deformity of the ingrown nail. The toenail is then covered with gauze and cotton cap added to ends of SE wire. Washing with soap, avoiding heavy exercise and trauma is important. Procedure takes 10-15 min and wire is allowed to remain in place for two to three months, after which can be pulled out with pliers. In case of Trumpet nail, procedure is repeated as nail grows.
Important considerations for treatment with the SE wire are that the width of the free border of the affected nail be greater than 2 mm and that the angle of the nail plate is within 90°. It is useful for infected and uninfected nails with no contraindications. This method doesn't require anesthesia, is convenient, low-cost, effective therapy and can be done in outpatient clinics.
Autologous Fat Transplantation for Depressed Linear Scleroderma-Induced Facial Atrophic Scars
Roh MR, Jung JY, Chung KY
Dermatologic Surgery 2008;34:1659-65
Facial linear scleroderma results in depressed atrophic scars. Autologous fat transplantation (AFT) has been widely used, as a material for filling depressed atrophic scars and contour deformities. However, long-term results for AFT are controversial. A retrospective study of 20 patients of linear scleroderma who received at least two AFTs, and were followed up for at least 12 months after the last treatment is reported.
Twenty patients of linear scleroderma, who were free from active disease, were treated with AFT. The AFT donor sites (usually buttocks or lower abdomen), were tumesced with Klein's solution. After 20 min for vasoconstriction, fat was aspirated using 10-cc Luer lock syringe and blunt 14-G cannula. It was rinsed with Hartmann dextrose until blood was cleared and then transferred to syringes for injection with an 18-G cannula. Nerve or field blocks were done in the recipient area using 1% lidocaine with 1:100,000 epinephrine. Fat was injected throughout multiple planes until slight overcorrection. Remaining fat was stored at 4°C for
2 h and then slowly cooled to −20°C for 2 h followed by long-term storage at −70°C. Patients were examined one week postoperatively, and further injections were done at three-month intervals using frozen fat.
After 12 months of the last treatment, there was 51- 75% improvement on the forehead, 25% on the chin. Infraorbital area showed fair correction, but nose showed poor correction.
Eyelid Tightening and Improved Eyelid Aperture through Non-ablative Fractional Resurfacing
SukaL SA, Chapas AM, Bernstein LJ, Hale EK, Kim KH, Geronemus RG
Dermatologic Surgery 2008;34:1454-8
Fractional photothermolysis (FP) using Fraxel 750SR laser, which uses 1550-nm erbium-doped fiber laser system is a recently described technique for non-ablative fractional resurfacing for facial photorejuvenation. A retrospective study of 31 patients (with mean age 55.3 years) was done for its effect on eyelid tightening and eyelid aperture. Photographs were taken pre-treatment and post-treatment three to four weeks after the last treatment. The therapy used pulse energy of 17 to 20 mJ at 125 microthermal zones (MTZs)/cm² to a final density of 500 to 750 MTZ/cm² using 15-mm treatment tip. Each patient had three to seven treatments, two to three passes per area. Eye shields were not used as lid was retracted over orbital rim while the patients maintained closed eyes. Treatment interval was three to four weeks. Eyelid tightening was evaluated on a four- point evaluation scale. Eyelid aperture was judged as larger or not changed. All patients achieved some degree of eyelid tightening; 19% had 1-25% tightening, 26.9% had 25-50%, 25.8% had 50-75%, and 19.4% achieved 75-100% tightening. Increase in eyelid aperture was seen in 55.9%. Scarring, hypo/hyperpigmentation, persistent erythema, and postoperative wounding were not observed.
Fractional resurfacing effectively tightens and increases the aperture of eyelids, giving a more youthful appearance to the aging face without wounding, downtime, or long-term complications.
Infectious Complications after Non-ablative Fractional Resurfacing Treatment
Setyadi HG, Jacobs AA, Markus RF
Dermatologic Surgery 2008;34:1595-7
Fractional photothermolysis/fractional resurfacing is a novel laser resurfacing procedure that yields excellent cosmetic results with minimal side-effects. However, side-effects have been reported after the treatment.
Case 1: A 54-year-old lady with history of recurrent perioral herpes simplex virus (HSV) infection desired skin rejuvenation. Patient was on prophylactic valacyclovir 500 mg twice a day for five days with each laser treatment, starting the night before treatment. Post procedure recovery (Fraxel 1550nm 9mj/MTZ) was uneventful. But in the second session (a month later), patient missed taking the antiviral prophylaxis, and after four days of laser treatment developed perioral HSV lesions.
Case 2: A 57-year-old woman underwent fractional facial photorejuvenation for her extensive photodamage and rhytides using Fraxel-1550nm at fluence of 9mJ/MTZ over face and 12mJ/MTZ over perioral area. Twelve hours post procedure patient developed impetigo.
The use of acyclovir 400 mg twice a day from one day before treatment to prevent HSV reactivation in patients with history of recurrent HSV infection, is recommended. Prophylaxis for bacterial infection, however, is not mandatory as this is only an anecdotal report.
Outcomes of Treatment with Carbon Dioxide Laser in Nine Cases of Recalcitrant, Severe Hidradenitis Suppurativa
Madan V, Hindle E, Hussain W, August PJ
Br J Dermatol 2008;159:1309-14
Nine patients (8F, 1M) with mean age of 39 years, with recalcitrant hidradenitis suppurativa (HS), with mean duration 9.3 years, were treated with CO 2 Laser (Sharplan 40 C; 18-25 W freehand). All patients had previously undergone several modalities of treatment such as isotretinoin, antibiotic, cyproterone acetate, steroid or infliximab and surgery but had failed to respond.
Twenty-seven sites were treated in 19 sessions on nine patients. Small isolated diseased apocrine glands evident as polyporous comedones were ablated by percutaneous vaporization until a small yellow nodule of apocrine gland 3-4 mm across was identified about 5 mm deep. These too were vaporized leaving up to 10-15 small cavities, 3-4 mm across, and left to granulate. More severe HS lesions were excised in total using the CO 2 laser in its cutting mode (25-40 W in focus) until normal healthy nonvascular subcutaneous fat was reached. Topical mupirocin with colloid dressing for open wound and dry dressing for sutured wound was administered. Ciprofloxacin 500 mg bid orally for 14 days was given. All patients rated their postoperative discomfort as less or equal to their preoperative state. One year later a retrospective study with telephonic questionnaire was carried out. Seven of the nine patients had complete remission. An important complication was scar contracture in two patients. High level of patient satisfaction is reported with CO 2 laser treatment.