Journal of Cutaneous and Aesthetic Surgery
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  Access statistics : Table of Contents
   2018| July-September  | Volume 11 | Issue 3  
    Online since November 9, 2018

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Surgical management of onychopapilloma, onychomatricoma, and subungual osteochondroma: Case series
Swagata A Tambe, Saba M M Ansari, Chitra S Nayak, Ramya Chokkar, Priyanka D Patil
July-September 2018, 11(3):143-147
DOI:10.4103/JCAS.JCAS_72_18  PMID:30533990
The clinical diagnosis of benign and malignant nail tumors can be difficult. Dermoscopy can provide a clue to the diagnosis but nail biopsy is the gold standard in establishing the diagnosis. Here, we report three cases of rare nail tumors, that is, onychopapilloma, onychomatricoma, and subungual osteochondroma, which were diagnosed on histopathology and managed surgically.
  3,241 98 -
Comparative (quantitative and qualitative) analysis of three different reagents for preparation of platelet-rich plasma for hair rejuvenation
Sukhbir Singh
July-September 2018, 11(3):127-131
DOI:10.4103/JCAS.JCAS_108_18  PMID:30533986
Objective: The aim of this study was to compare the quantity and quality of platelets in platelet-rich plasma (PRP) samples prepared using three different reagents, namely, ethylenediaminetetraacetic acid (EDTA), sodium citrate, and acid citrate dextrose-A (ACD-A) solution. Materials and Methods: A prospective study was carried out in which all the 50 patients who attended the outpatient department for hair rejuvenation were enrolled for the study. All the patients had a history of hair fall with diffuse thinning of hair, Norwood Grades 2 and 3. Patients with complete hair loss were not included in the study. No specific randomization was carried out. All the patients were explained about the procedure and the use of vials containing the aforementioned three reagents. Then, 40mL blood was taken from each patient. Both quantitative and qualitative analyses of platelets were carried out on PRP samples. Quantitative analysis was done by using an automatic cell counter and cross-checking manually. Qualitative analysis was carried out by preparing smears from each of the three samples from each vial. All the patients were followed up at 4 weekly intervals for a duration of 6 months and then at the end of 1 year. All the patients received six sessions of PRP. Results: All the data were subjected to statistical analysis using Student’s t-test, and P value of <0.001 was obtained in samples from ACD-A vials, which was statistically significant. In all the 50 patients, the samples collected in vials containing ACD-A yielded the maximum quantitative count and the best morphology of platelets under smear examination. Conclusion: Within the limits of this study, we would like to conclude that ACD-A vials should be used for collecting and processing blood for PRP preparation to obtain best results in hair rejuvenation.
  2,314 253 -
Extensive Nicolau syndrome following intramuscular injection of paracetamol in a patient who is HIV positive
Tasleem Arif, Konchok Dorjay
July-September 2018, 11(3):136-139
DOI:10.4103/JCAS.JCAS_53_18  PMID:30533988
Nicolau syndrome (NS) is a type of adverse skin reaction occurring after parenteral drug injection. In certain conditions, it can cause ischemic necrosis of the skin and the underlying adipose tissue. The actual cause of NS is not clear though inflammation, vasospasm, and thromboembolic occlusion of blood vessels have been proposed. In this case presentation, we report an interesting case of a 30-year-old man who turned out be human immunodeficiency virus (HIV) positive on investigations, developed extensive purpuric lesions of his skin on left buttock and then spread to the trunk and shoulders after receiving intramuscular injection of paracetamol. With a suggestive history and further supported by clinical examination, a diagnosis of NS following injection of paracetamol was made. Though NS is considered to be rare, at times it can be devastating. Being a common procedure in the life of a health-care professional, the awareness regarding this entity is very essential. Despite intense medical literature search in, we could not find a single report of NS after intramuscular injection of paracetamol in a patient who is HIV positive, thus obliging this communication.
  2,364 114 -
Gentle is better: The original “gentle technique” for fat placement in breast lipofilling
Pietro Gentile, Barbara De Angelis, Verdiana Di Pietro, Vittoria Amorosi, Maria G Scioli, Augusto Orlandi, Valerio Cervelli
July-September 2018, 11(3):120-126
DOI:10.4103/JCAS.JCAS_24_18  PMID:30533985
Context: Breast lipofilling usually involves three different stages (harvesting, processing, and placement), and in each of these phases, adipocyte cells can be damaged. Our technique of fat placement is quite different from the others as we focus our attention on the last stage of fat graft procedure, which could explain the better results in graft survival. Aims: Our method is focused on eliminating any unnecessary manipulation of the graft so as to optimize graft retention and clinical outcomes: Controlled movement and slow rate of fat injection are the cornerstone of our technique and guarantee a nontraumatic fat transfer and a greater survival rate of adipocytes. Settings and Design: This was a retrospective cohort study. Materials and Methods: Of 120 patients (average age 41,5 years) affected by breast soft tissue defects, 60 were managed with the lipofilling procedure using fat graft injected by “Gentle technique.” To establish the effects of the injection’s procedure, we compared the results obtained in fat graft maintenance with a control group made up of 60 patients, treated with fat graft injection according to Coleman procedure. Statistical Analysis Used: Values are expressed as mean plus standard error and analyzed using Student’s t test. Results: In patients treated with Gentle technique, we observed a 60.5% + 12.5% maintenance of contour restoring and three-dimensional volume after 1 year (P < 0.0001 vs. control group); we compared the results obtained with only 39% + 4.4% of the control group treated with fat graft injected according to Coleman. Conclusions: Controlled 26 movement and slow rate of fat injection are the cornerstone of our technique and guarantee a nontraumatic fat transfer and a greater 27 survival rate of adipocytes.
  2,258 93 -
Fourth dimension in reconstruction of defects following excision of basal cell carcinoma of head and neck!
Kandasamy Mahadevan, Sridhar Sruthi, Shanmugam Sridevi, Rajamanoharan Vivek
July-September 2018, 11(3):110-119
DOI:10.4103/JCAS.JCAS_100_17  PMID:30533984
Background: Basal cell carcinomas (BCCs) are the most common skin tumors of the face. Excision results in soft tissue defects that require reconstruction with the focus on form, function, and patient satisfaction. Aim: To analyze the reconstruction of BCC excision defects of the head and neck region using local flaps and skin grafts with respect to the four dimensions of oncological reconstruction: clearance, form, function, and patient satisfaction. Materials and Methods: This is a prospective study conducted on 88 patients who presented with BCC of the head and neck region and who were operated in our hospital from January 2015 to December 2016 with a minimum follow-up period of 6 months up to June 2017. All patients underwent wide local excision and reconstruction using appropriate local flaps or split-thickness skin graft (SSG). Patients were analyzed with respect to age, sex, site, size, reconstruction method, complications, and patient satisfaction using the customized Patient Satisfaction Questionnaire (PSQ), derived from PSQ III. Results: A total of 77.3% defects were immediately reconstructed using local flaps and 18.2% underwent SSG. All flaps and grafts survived well with a complication rate of 6.8%. Approximately 72.7% of patients had good satisfaction with the medical care and reconstruction. Conclusion: Post-excisional defects of BCC in the head and neck region have to be reconstructed with equal weightage to the four pillars of oncological reconstruction: clearance, form, function, and patient satisfaction. Flap reconstruction is ideal as it brings about reconstruction with patient satisfaction, which is indeed the fourth dimension in any reconstructive surgery.
  1,958 104 -
A pocket-friendly and sustainable iontophoresis apparatus for palmoplantar hyperhidrosis: Advancement over a previously described homemade design
Sourabh Jain, Vivek K Dey, Nihit Agrawal
July-September 2018, 11(3):153-156
DOI:10.4103/JCAS.JCAS_58_17  PMID:30533993
Introduction and Objectives: Tap water iontophoresis is a promising therapy for palmoplantar hyperhidrosis. Non-affordability and nonavailability of the marketed device restrict its usage for many patients hailing from villages or small cities. Materials and Methods: In an article named “A simple user-made iontophoresis device for palmoplantar hyperhidrosis” published previously in this journal, a simple inexpensive homemade device that runs on 12 V direct current battery was described. We made a small modification by using a 220–12 V alternate current to direct current semiconductor diode–based transformer for the current supply. Results: The added innovation made the device lightweight, cheaper, and usable with domestic electric supply at home/clinic. Sustained supply of current at same voltage without dip and non-requirement to change/replace battery are added advantages. Cost of the whole assembly is ₹310. Working and clinical efficacy of our device were comparable to the commercially available apparatus as reported by 13 patients who received thrice a week of 15min sessions with our device. Mild electric pricking sensation was felt by all patients. Four of thirteen reported that pricking sensation was a bit more with our device as compared to the marketed device. No calibration for intensity is available in our device. Conclusion: This simple to assemble and inexpensive device makes iontophoresis applicable in many needy patients with similar efficacy and few limitations compared to expensive marketed devices.
  1,937 117 -
Objective quantification of liposuction results
Alain J Azzi, Ann-Sophie Lafrenière, Alex Viezel-Mathieu, Thomas M Hemmerling, Mirko Gilardino
July-September 2018, 11(3):105-109
DOI:10.4103/JCAS.JCAS_102_18  PMID:30533983
Currently, no reliable gold standard exists for the objective outcome measurement following liposuction. The purpose of this systematic review was to summarize reported methods of monitoring liposuction results by objectively measuring subcutaneous adipose tissue. A systematic literature search was performed to identify relevant articles that described techniques for objectively quantifying adipose tissue following traditional liposuction. The search included published articles in three electronic databases—Ovid MEDLINE, Embase, and PubMed. Subcutaneous adipose tissue was estimated using the following techniques: ultrasound, dual-energy X-ray absorptiometry, magnetic resonance imaging, computed tomography, and three-dimensional imaging volumetric analysis. Reported benefits of liposuction objective measurements included providing patients with a quantitative assessment of the liposuction results pre- and postoperatively, detecting significant changes in body fat deposits, and following patterns of fat redistribution. This review provides a summary of various techniques for quantification of liposuction results. More studies are needed to study the clinical relevancy and impact of the various imaging modalities reviewed as well as to develop automated volumetric measurement technology with improved accuracy, efficacy, and reproducibility.
  1,844 140 -
Mondor’s disease after aesthetic breast surgery: A case series and literature review
Alberto Goldman, Uwe Wollina
July-September 2018, 11(3):132-135
DOI:10.4103/JCAS.JCAS_69_18  PMID:30533987
Background: Mondor’s disease of the subcutaneous veins of the breast is an uncommon disorder. The etiology of Mondor’s disease remains unclear. Usually, it is a self-limited disease. This condition has been associated with trauma, surgical biopsies, breast surgery (including silicone breast implant), physical activity, and a manifestation of breast cancer. Materials and Methods: This is a retrospective analysis of 652 female patients who underwent aesthetic breast surgery in the last 10 years. Results: We found three cases of Mondor’s disease after plastic surgery of the breast (0.46%) and performed an analysis of the clinical aspects and therapeutic measures. The disease onset was a couple of weeks to 2 years after surgery, never within the first 2 weeks after surgery. We did not observe ulceration or breast cancer. Treatment was unnecessary in two patients, whereas hot compresses and nonsteroidal medical drugs were prescribed in one patient. All lesions healed within 2–3 weeks. Conclusion: Mondor’s disease is a possible complication after aesthetic breast surgery but often runs a self-limiting course with spontaneous remission. It is important to exclude breast cancer. The patient should be informed that the disease runs a benign and self-limiting course.
  1,629 59 -
Chemical peeling for nail disorders: Need for a systematic approach
Sidharth Sonthalia, Ramanjit Singh
July-September 2018, 11(3):161-163
DOI:10.4103/JCAS.JCAS_106_17  PMID:30533995
  1,388 116 -
Harmonic devices: The workhorse for surgical resection of vascular malformations
Chirayu Parwal, Lalit Choudhary, Anurag Pandey, Vivek Kumar, Puran Singh, Jessy Ragi
July-September 2018, 11(3):157-160
DOI:10.4103/JCAS.JCAS_52_17  PMID:30533994
Management of vascular malformations is multimodal with documented role of surgical resection in specific facets of this condition. Surgical resection of these lesions is technically challenging owing to diffuse and relatively ill-defined extent with involvement of multiple tissue planes limitation of access and excessive intra-operative bleeding. An observational study was conducted in 24 cases taken up for surgical resection of vascular malformations. The cases were divided into two groups based on the hemostasis technique used: Group A: Harmonic shears (n = 12) (Ethicon Inc. Somerville, New Jersey, United States). Group B: Electrosurgery (monopolar/bipolar) with standard knot tying (n = 12). We conclude that use of harmonic scalpel in surgical resection causes less parallel tissue damage, secures haemostasis promptly, does not impede vision and aids surgical dissection thereby significantly reducing the operative time and improving the surgical outcome, typically in large vascular malformations of head and neck region.
  1,371 50 -
Innovative skin hook
Saurabh Gupta, Devi P Mohapatra, Ravi K Chittoria, Elankumar Subbarayan, Sireesha K Reddy, Vinayak Chavan, Abhinav Aggarwal, Likhitha C Reddy
July-September 2018, 11(3):148-149
DOI:10.4103/JCAS.JCAS_76_18  PMID:30533991
Skin hook is an important instrument for skin surgeries. There are situations, such as operating in a health camp or operating at a peripheral health center with a limited number of instruments, where skin hook is not available in the operation theater. We present an innovative design of skin hook, which can be prepared by surgeons in the operation theater with the help of readily available materials. The innovative skin hook is a simple, safe, and effective solution for performing skin surgeries in a limited-resource setup.
  1,285 98 -
Maintenance of the anatomic contours in auricular reconstruction: The button technique
Brandon Worley, Joel L Cohen
July-September 2018, 11(3):150-152
DOI:10.4103/JCAS.JCAS_71_18  PMID:30533992
Background and Objective: Reconstructing the contours of the auricle is a unique challenge. Various bolster techniques have been tried to help prevent complications such as hematoma, seroma, and morbidity. Here, we describe a simple technique using a button to maintain the natural ear contour when it is at risk of a poor aesthetic outcome. Materials and Methods: A 77-year-old man underwent resection of a squamous cell carcinoma of the postauricular skin on the right ear, which involved the helical margin. A skin graft was chosen to close the defect. However, on initial inspection of the repair, buckling of the scaphoid fossa, collapse of the antihelical fold, and notching of the helix were observed. When these buckling changes persisted even after the anesthesia-related swelling resolved the following day, a button bolster was placed for 2.5 weeks to provide support for the cartilage. Results: Standardized digital imaging revealed maintenance of the original contours and sulci of the ear with an excellent cosmetic result. Conclusion: Recreation of the auricular contours is critical for an excellent cosmetic outcome. Using a button bolster is worth considering as it is of low cost, can easily fit into the natural ear contours, and can provide a rigid structure to ensure maintenance of the ear shape.
  1,264 71 -
Surgical management of onychoheterotopia
Chander Grover, Geetali Kharghoria
July-September 2018, 11(3):140-142
DOI:10.4103/JCAS.JCAS_84_18  PMID:30533989
Onychoheterotopia (ectopic nail) is a rare condition characterized by the development of nail tissue, distinct from the normal nail unit. It is usually acquired following traumatic inoculation of nail matrix; the congenital variety being less common. The exact pathogenesis of the disease is not clear. It affects the dorsal aspect of fingers and toes mostly. Herein, we report a case of a 35-year-old man with post-traumatic onychoheterotopia of left middle finger, who was treated with surgical avulsion of the ectopic nail along with chemical matricectomy of the well-formed ectopic matrix. The patient had a satisfactory cosmetic outcome with normal growth of the nail unit and no recurrence. The report serves to highlight clinical presentation of acquired onychoheterotopia along with its surgical management.
  1,259 56 -
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