Journal of Cutaneous and Aesthetic Surgery
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   2021| January-March  | Volume 14 | Issue 1  
    Online since March 27, 2021

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Expert consensus on soft-tissue repositioning using absorbable barbed suspension double-needle threads in Asian and Caucasian patients
Salvatore P Fundaro, Chee Leok Goh, Kwun Cheung Hau, Hyoungjin Moon, Purita P Lao, Giovanni Salti
January-March 2021, 14(1):1-13
Bioabsorbable barbed suspension double-needle threads have recently been thrust into the limelight as a minimally invasive alternative for skin repositioning. When compared to surgical face lifting, use of these threads requires reduced procedural and recovery time, no general anesthesia, confers immediate patient satisfaction, with no cutaneous incisions and no apparent scars, and is more tolerable. There is currently limited literature providing clinical guidance on the use of these suspension threads; hence, this consensus document was developed as the first publication to discuss the technical aspects of facial rejuvenation using the double-needle barbed bioabsorbable and hydrolyzable thread composed of copolymer poly (ε-caprolactone-co-L-lactic acid) or PCxLyA, that is, Definisse threads. The Board of Aesthetic Leaders and Investigators (BALI) is a panel of dermatologic surgery and plastic surgery experts who convened last July 2018 in Indonesia to discuss the aforementioned challenges. A thorough literature search was done where a review of specific technical recommendations based on prevailing practice and available guidelines pertaining to suspension threads were described and are summarized in this paper. A detailed list of pretreatment recommendations in the assessment of both Asian and Caucasian facial types, aging facial types, guidance on insertion techniques, and aftercare instructions for clinicians to review has been included here.
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Double helix bandage using toilet roll as toe separator to manage intertrigo
Karalikkattil T Ashique, Chakravarthi R Srinivas, Vamshi Krishna, Satyajit Sahu
January-March 2021, 14(1):108-108
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Tunneled flaps: An ingenious reconstructive option for anterior auricle defects
Diogo Cerejeira, André Pinho, Ana Brinca, Joao Goulao, Ricardo Vieira
January-March 2021, 14(1):14-19
Background: The anterior surface of the auricle is especially susceptible to a variety of traumatic insults and cutaneous malignancies. However, given the unique anatomy of this structure and the lack of local tissue available, the reconstruction of these defects is still a challenge. Despite of their positive outcomes, tunneled flaps have not been thoroughly explored in the literature. Objectives: To review the clinical utility of tunneled flaps in reconstructing anterior auricle defects. Materials and methods: A review of the literature on surgical reconstruction of the anterior auricle surface was performed in PubMed, with specific reference to tunneled flaps. Conclusions: When designed and executed properly, tunneled flaps offer unrivalled opportunities to reconstruct anterior auricle defects, with maximal preservation of the symmetry.
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Fractional carbon dioxide laser versus fractional carbon dioxide laser with autologous intralesional platelet-rich plasma in the treatment of stable, non-segmental vitiligo: A randomized comparative study
Annie Raizada, Maitreyee Panda, Bhabani STP Singh, Bikash R Kar
January-March 2021, 14(1):49-57
Background: The treatment of vitiligo is often challenging and requires a multi-modality approach. Fractional carbon dioxide (FCO2) laser has been studied as an adjuvant therapy in cases of vitiligo. Autologous platelet-rich plasma (PRP) is rich in growth factors, which may contribute to the growth of melanocytes, and thus help in the repigmentation of vitiligo patches. We aimed to study the combination of these two modalities for the treatment of vitiligo. Aims and Objective: The aim of this study was to compare the efficacy and safety of FCO2 laser with PRP and FCO2 laser alone as an adjuvant therapy in stable non-segmental vitiligo (NSV) patients. Settings and Design: A prospective, randomized, comparative, open-label interventional study was carried out for a period of 18 months from December 2017 to June 2019, at a tertiary care hospital. Materials and Methods: Seventy patients with stable, NSV were assessed for eligibility; 66 patients were randomized equally into two groups. Group A received treatment with FCO2 laser with intralesional PRP, whereas Group B was treated with FCO2 laser alone. Patients in both the groups were treated with one therapy session and were followed up monthly for a period of 3 months. All the patients received topical psoralen with ultraviolet A (UVA) PUVA-sol treatment. Baseline and monthly assessments were done by VITILIGO AREA SEVERITY INDEX and standardized photographs. Results: VASI score reduction was significantly more in the Group A with (mean ± standard deviation [SD]) 9.5 ± 0.22, 5.8 ± 1.12, and 3.6 ± 1.81 as compared to Group B 11.9 ± 2.83, 9.9 ± 3.11, and 8.9 ± 3.46 at each subsequent follow-up visits, respectively. Side effects such as burning sensation, erythema, and crusting were seen less frequently and lasted for a short period in Group A in comparison to those in Group B. Conclusion: Combination of FCO2 laser and autologous intralesional PRP has a synergetic effect in treating patients with vitiligo as an adjuvant therapy with minimal adverse effects.
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Split-face comparative study of efficacy of platelet-rich plasma combined with microneedling versus microneedling alone in treatment of post-acne scars
AS Nandini, Sana M Sankey, CS Sowmya, BC Sharath Kumar
January-March 2021, 14(1):20-25
Context: Skin conditions contribute substantial burden toward global morbidity and mortality. Acne vulgaris, with its rising prevalence, has become a cause of concern among researchers as well as dermatologists due to scarring. Aims: The aim of this study was to compare the efficacy of microneedling alone versus microneedling combined with platelet-rich plasma (PRP) in post-acne scars using a split-face method. Materials and Methods: Thirty patients with atrophic post-acne facial scars were offered four sittings of treatment monthly once. As a standard protocol, the right side of the face was subjected to microneedling with PRP (Group A) and the left side of the face with microneedling alone (Group B). Objective evaluation of improvement was performed by the physician recording the acne scar assessment score at baseline and thereafter at every visit using Goodman and Baron scale. Alongside patients also graded the improvement in acne scars at the end of the study. Statistical Analysis Used: The collected information was entered in MS Excel (Bellevue, WA, USA) and analyzed using appropriate statistical methods with Statistical Package for the Social Sciences software (IBM Corp., Armonk, NY). The significance of the outcomes of the study was assessed by calculating the P value and the value of P < 0.05 was considered statistically significant. Results: The mean age of patients was 25 years. Thirteen (43%) patients in Group A had an excellent response as compared to 6 (20%) patients in Group B according to physician assessment. Patient’s satisfaction was more in Group A as compared to Group B as 11 (36%) patients had more than 75% improvement in Group A as compared to 1 (3%) patient in Group B. Conclusion: The study showed a decrease in scar severity grade in all the patients enrolled for treatment. However, the combined use of microneedling and PRP was found to be more effective than a single method used for treatment of acne scars.
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A study of Q-switched Nd:YAG laser versus itraconazole in management of onychomycosis
Renu Kandpal, Sandeep Arora, Divya Arora
January-March 2021, 14(1):87-110
Context: Onychomycosis (OM) accounts for 20%–40% of all nail disorders. Slow growth of nails, resistance to antifungal drugs, their side effects, and drug interactions limit treatment options. Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser is approved for nail clearance of OM, however conflicting reports exist in literature about its efficacy. This study was conducted to compare the efficacy of Q-switched Nd:YAG laser. Aim: The aim of this study was to find the efficacy of Q-switched Nd:YAG laser (1064 nm) management of OM as monotherapy in comparison to itraconazole. Settings and Design: A randomized parallel group, outcome assessor trial was conducted over 18 months from July 1, 2015 to December 31, 2016, at skin center of a tertiary care hospital. Subjects and Methods: In the first group, patients of OM were administered 12 weekly sessions of the laser. Second group was administered itraconazole 200 mg twice a day for 1 week per month for the 3 months. Confirmed cases of OM, who had not received treatment 6 months before presentation, were selected and randomly allocated to two groups of 50 each. Onychomycosis severity index (OSI) and visual analog scale (VAS) score were used to assess nail involvement at the start of study, 3 months and 1 year after enrollment. Statistical Analysis: Clinical profile of patients was analyzed by chi-square test for qualitative variables. For comparison of quantitative variables, Student t test was performed. A 5% probability level was considered as statistically significant (P < 0.05). Results: VAS and OSI showed statistically significant improvement at 3 and 12 months in Group I, while resulting in faster clearance with laser; OSI was comparable in both groups at 12 months. Mycological cure was significantly higher in Group I. Both dermatophytes as well as non-dermatophytes responded well to laser treatment, whereas non-dermatophytes responded better to laser. Conclusions: Q-switched Nd:YAG laser is effective in inducing nail clearance in OM and is better than itraconazole in managing non-dermatophyte OM.
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A retrospective study supporting the importance of individualizing the dose of botulinum toxin according to the age
Bruna Souza Felix Bravo, Raquel de Melo Carvalho, Bruna Fanton Gallo, Leonardo Gonçalves Bravo
January-March 2021, 14(1):82-86
Background: Botulinum toxin type A injection remains the leading nonsurgical cosmetic procedure worldwide with a high rate of efficacy and patient satisfaction. Objective: This study aims to demonstrate the importance of individualization of botulinum toxin doses to treat the upper face according to the age of the patients, considering the muscles particularities and the specificities of each face area. Materials and Methods: A retrospective study with 389 female patients treated with botulinum toxin type A in the upper third of the face (forehead, glabellar, and periorbital lines). Statistical analysis of the data was performed. Results: The mean age was 47.49 years old and the median total dose of botulinum toxin type A was 53.76 units, whereas the median dose in the glabella was 26.28 U, the mean forehead dose was 12.23 U, and in the periorbital area was 14.79 U, adding both sides. It is possible to observe that the doses are negatively correlated with age, except in the periorbital area, where an increase in the dose was observed. Conclusion: It is important to highlight that although there is consensus on pre-established dose suggestions, the treatment should be individualized, respecting the individual characteristics of each patient.
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Comparative evaluation of efficacy of non-cultured epidermal cell suspension and epidermal curettage in stable vitiligo
Shashank Tyagi, Suresh K Malhotra, Tejinder Kaur
January-March 2021, 14(1):26-34
Context: Vitiligo is a common primary acquired pigmentary disorder due to loss of epidermal functioning melanocytes. Many surgical techniques have evolved over the years for its treatment and the need of a cost-effective modality has always been put forward. Aim: The aim of the study was to compare the efficacy of non-cultured epidermal cell suspension with that of epidermal curettage in repigmentation of stable vitiligo. Settings and Design: It was a prospective randomized non-controlled study. Subjects and Methods: Forty lesions were selected in patients of stable, recalcitrant vitiligo belonging to different age-groups and genders. After histopathological confirmation, the patients were taken up for surgery after obtaining written consent and were divided into two groups for two different procedures, that is, non-cultured epidermal cell suspension (Group A) and epidermal curettage (Group B). Follow-up was carried out at 2, 4, 8, and 12 weeks of procedure to assess the repigmentation achieved. Statistical Analysis: Statistical Package for Social Sciences (SPSS) software, version 21.0, was used. Results: At the end of the study, >50% repigmentation was achieved in 95% (19 of 20) lesions of Group A and 85% (17 of 20) lesions in Group B, whereas >75% repigmentation was achieved in 60% (12 of 20) in both Groups A and B. The color matching with surrounding skin and yield of graft was better in epidermal cell suspension technique than that in epidermal curettage. The difference was not statistically significant. Conclusion: Though both the surgical techniques of melanocyte transplantation are effective in achieving uniform pigmentation, epidermal curettage has an extra edge of being simpler and more cost-effective.
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Innovative technique for securing autologous melanocyte-keratinocyte cell transplant (MKCT) suspension in stable vitiligo
Sharad Dattatray Mutalik, Yashashree Dhaval Rasal
January-March 2021, 14(1):132-135
Autologous cultured melanocyte transplantation is a safe and effective cellular regenerative surgical treatment modality for the lesions of stable vitiligo. Research continues to improve the efficacy of cell transplants by refining the procedure. The method of dressing used to secure the cell suspension over the treated site is vital in deciding the extent of repigmentation. The authors propose a simple modification in the dressing technique, which provides better graft adherence and results in uniform repigmentation, especially on challenging areas such as joints and other curved body surfaces.
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Thread lifting of the jawline: a pilot study for quantitative evaluation
Alberto Diaspro, Massimo Luni, Gabriele Rossini
January-March 2021, 14(1):41-48
Introduction: The facial aging process produces changes that are characteristic of the superficial and deep fat framework and skin layers. Subdermal suspension with threads enables the sagging tissues to be lifted by means of a minimally invasive, closed procedure without surgical dissection. This observational study has been carried out on the basis of standardized tridimensional photographic analysis and measurement, aimed at determining objective, repetitive, and reliable evaluation of the soft tissue suspension technique. Materials and Methods: Eight participants were enrolled in this pilot study presenting with mild to moderate ptosis of the jawline tissues. Patient photographs were taken before (t0), immediately after threads implantation (t1), and at the following visit (t2). Each image captured before thread insertion was registered by the software and surface linear lengths in between the mentioned points were calculated. Results: The result showed an overall average improvement in the “tragus-to-marionette distance” (C-A) and the “tragus-to-jowl distance” after a mean follow-up time of 8.16 months (t0-t2). All analyzed parameters improved significantly (P < 0.05) at t1 and at t2 with respect to t0. Conclusions: This pilot study suggest that facial tissue suspension by means of poli-lactic/poli-caprolactone threads is safe and effective in treating skin flaws that affect mild-to-moderate ptosis of the jawline up to 8 months.
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Horn on the nail: Acquired ungual fibrokeratoma
Noor Jahan, Padubidri Kombettu Ashwini, Santhebachall Gurumurthy Chethana, Jayadev Betkerur, Veeranna Shastry
January-March 2021, 14(1):115-118
Acquired ungual fibrokeratomas are uncommon fibrous tissue tumors that are located in the ungual area. They usually presents as asymptomatic, solitary, smooth, dome-shaped, or fingerlike, flesh-colored papules accompanying nail deformities, including a longitudinal groove and trachyonychia. Acquired periungual fibrokeratoma is considered a topographical variant of acquired digital fibrokeratoma; it has a unique “garlic clove” shape. A traumatic origin has been suggested, as acquired ungual fibrokeratomas occur most frequently on the fingers and toes. Herein, we report a case of a 29-year-old man with growth over left little finger, who was treated with surgical excision of the tissue. Histopathological examination confirmed ungual fibrokeratoma. It is a rare variant of digital fibrokeratoma, and so far the first ungual fibrokeratoma to appear de novo on little finger to the best of our knowledge.
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Fractional carbon dioxide laser versus combined fractional carbon dioxide laser with platelet-rich plasma in the treatment of atrophic post-acne scars: A split-face comparative study
Saurabh Sharma, Jasleen Kaur, Tanreet Kaur, Roopam Bassi
January-March 2021, 14(1):35-40
Context: Though many treatment options are available for treating post-acne scars, optimized treatment still does not exist. Till date, comparative split-face studies, analyzing the efficacy of combined treatment modalities for acne scars with adequate sample size and with statistically significant results, are still lacking. Aim: The aim of this study was to compare the effectiveness of the combined use of platelet-rich plasma (PRP) and fractional ablative CO2 laser (FACL) versus FACL in the management of acne scars and to study the safety of autologous PRP and FACL in the treatment of post-acne scars. Settings and Design: This was a randomized split-face trial study. Materials and Methods: This study was conducted in 30 patients having Goodman and Baron’s grade 3 and 4 acne scars. The efficacy of PRP in combination with FACL was compared to FACL alone in the treatment of post-acne scars. Right half of the patient’s face was taken as the study side where FACL was performed followed by PRP injections. The left half of the same patient’s face was taken as the control side where FACL was performed followed by normal saline injections. Statistical Analysis: Results were analyzed using Statistical Package for the Social Sciences (SPSS, Chicago). Results: At the time of enrollment, mean Goodman and Baron Acne Qualitative Grading Scale on study and control side was 3.80 with standard deviation (SD) of 0.40 at baseline. After completion of four treatment sessions, it was reduced to 2.43 (SD = 0.76) and 2.76 (SD = 0.49) on the study and control side, respectively. Improvement on both sides was statistically significant (P = 0.000). Conclusion: There is no single proven modality for the effective treatment of post-acne scars. Combination of FACL with newer adjuvants such as PRP has definitive role in managing post-acne scars with better safety profile than FACL alone.
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Dual toning method with the combination of picosecond and microsecond Nd:YAG in refractory melasma unresponsive to picosecond alone
Le Hai, Bui Phuong, Le Ha, Vu Lam, Bui Van, Firas Al-Niaimi
January-March 2021, 14(1):95-100
Background: Melasma is an acquired and treatment-resistant aging facial skin condition prevalent among the older Asian females. The Q-switched toning laser is the most widely used for the treatment of moderate to severe melasma in Asia. Recently, the picosecond laser has been introduced for various pigmentary disorders such as melasma. We evaluated the efficacy and safety of dual toning combined with 1064 nm Nd:YAG picosecond and quasi-long-pulsed laser in the treatment of severe melasma. Subjects and Methods: Twenty Vietnamese females, mean age 41.9 ± 6.4 years, Fitzpatrick skin type IV, with clinical diagnosis of severe dermal and mixed-type melasma were treated by at least eight sessions picosecond Nd:YAG 1064 nm reducing Melasma Area and Severity Index (MASI) to less than 15%. Then they were treated with 3 sessions of dual toning combined picosecond Nd:YAG 1064 nm laser having an energy and spot size of 0.6–0.8 J/cm2 and 8 mm with micropulsed mode Nd:YAG 1064 nm laser (350 µs) having an energy and spot size of 2.6 J/cm2 and 15 mm with ICD off. Mild and even erythema was the endpoint (40–42°C using the infrared thermometer). Treatments were given every 4 weeks. Improvement was rated by MASI at the baseline (T1), after eight sessions of picotoning (T2), and three sessions of dual toning (T3). Results: The mean MASI score of 20 patients at baseline (T1) was 16.24 ± 4.88 (min 6.0; max 28.8); after at least eight picotoning sessions, the mean MASI was 15.12 ± 4.69, representing a 7.44 ± 4.41% reduction in MASI score. The MASI score of the dual toning laser continued to decrease after three dual toning sessions from 15.12 ± 4.6 to 9.77 ± 3.86 (MASI score reduced by a mean of 5.35 ± 2.64), achieving 35.15 ± 13.51% reduction from T2 and 40.17 ± 12.14% reduction from baseline MASI (T1). There were no unexpected side effects in any patients. Conclusion: The dual toning method using the 1064 nm Nd:YAG picosecond and microsecond laser was safe and effective and well tolerated by all patients without downtime. However, larger number of studies should be conducted with more objective measurement techniques to confirm the results of this preliminary study.
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A comparative study of microneedling alone versus along with platelet-rich plasma in acne scars
Meghna Gupta, Krishna Deb Barman, Rashmi Sarkar
January-March 2021, 14(1):58-65
Context: There are several modalities of treating acne scars. The combination of microneedling and platelet-rich plasma (PRP) is a synergistic approach to treat acne scars. Aims: The aim was to compare the efficacy of microneedling alone versus microneedling with PRP in acne scars. Materials and Methods: This was a split face study conducted on 36 patients with acne scars who underwent four sessions of microneedling with PRP on right side and microneedling alone on left side at monthly interval. The total scars with subtypes and Ecchelle D’Evaluation Cliniques des Cicatrices D’Acne (ECCA) score were assessed at baseline and second, fourth, and sixth visits. Visual analog score (VAS) was evaluated by both physicians and patients. Statistical Analysis: The statistical analysis was carried out using Statistical Package for Social Sciences. Paired-t test and Wilcoxon signed rank test were used to compare the results. Results: Mean age was 23.7±3.2 years with 17 male and 19 female patients. The mean total scars on right and left sides declined from 42.14±21.15 to 25.08±14.14 and 43.28+23.08 to 27.17±15.68, respectively, with insignificant differences (P-value = 0.094). ECCA score on right and left sides declined from 88.31±32.78 to 62.92±23.68 and 89.58±32.43 to 66.25±23.89, respectively (P-value = 0.058). VAS evaluated by patient and physician showed maximum improvement at second and third visits, respectively. Conclusions: This study showed no added advantage of topical application of PRP over microneedling in acne scars.
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Idiopathic guttate hypomelanosis treated with 308-nm excimer light and topical bimatoprost
Firas Constantin Kreeshan, Vishal Madan
January-March 2021, 14(1):109-111
Idiopathic guttate hypomelanosis (IGH) is an acquired pigmentary disorder that is characterized by the presence of multiple hypopigmented macules on the shins and forearms. Albeit asymptomatic, it can cause considerable cosmetic anxiety. The pathogenesis is not fully understood and to date, there have been no successful treatments. We report a case of a 48-year-old female who presented with an 8-year history of multiple hypopigmented macules on both legs, typical of IGH. She previously failed to respond to topical pimecrolimus. She received targeted phototherapy with an excimer lamp (308 nm, 250–480 mJ), and a small patch was treated once daily with topical bimatoprost, in addition to the excimer lamp. After five sessions, better improvement was noted on the combination treatment patch; she received combination treatments for further six sessions. Good repigmentation has been achieved on the smaller macules. The larger depigmented macules continue to improve with further treatments. A combination of excimer light with topical bimatoprost appears to be a promising potential treatment option for IGH, a condition where management options are otherwise limited.
  142 12 -
Nose reconstruction using local and regional flaps: The challenges and advantages
Venkatesh Mysore Srinivas, Manjunath Kalapurmat Nagabhushanaiah
January-March 2021, 14(1):71-77
Background: Nose is a central structure in midface. It has an important function in maintaining the aesthesis of the face. The three-dimensional (3D) structure of the nose is challenging to reconstruct. However, the availability of abundant vascularity and surrounding tissue is advantageous for the reconstruction of the soft tissue. Hence, this study was carried out to assess the cosmetic outcome and acceptability of patients undergoing nasal soft tissue reconstruction using local and regional flaps. Materials and Methods: Patients undergoing nasal soft tissue reconstruction using local or regional flaps, between January 2017 and December 2018, were studied. Patients requiring free flaps or skin grafts for reconstruction were excluded from the study. All the patients during follow-up at 3–6 months were asked to rate cosmetic acceptability and donor site cosmesis as bad, good, and very good. Results: In this study, 15 cases of nasal soft tissue reconstruction were studied. Among the 15 cases, 9 (60%) were male and 6 (40%) were female; the age range of patients was 7–65 years. Majority of the patients (5, 33.3%) had trauma as major cause of deformity. Post malignancy excision defect was the next major cause. All patients were happy with the results, only patient with composite graft complained regarding hyperpigmentation. Conclusion: Nose is an important structure in the midface. Apart from olfaction and respiration, maintaining adequate cosmesis is also an important function of the nose. Any deformity of the nose can be devastating to the patient. But, the 3D structure with varied structures makes reconstruction challenging to recreate. However, the availability of adequate donor tissue in local and surrounding region makes it advantageous. If principles of reconstruction are followed strictly, the outcome is good. Tissue expansion can be used whenever soft tissue requirement is more.
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Split-thickness skin graft harvest under local anesthetic: A single pass technique
Ardit Begaj, Christian M Asher, Alexander E Hamilton
January-March 2021, 14(1):101-103
Adequate local anesthetic, in harvesting a split-thickness skin graft (SSG), traditionally involves multiple passes of a needle across the length and width of the marked donor site. We describe a technique using hyaluronidase to uniformly anaesthetize an SSG donor site with one injection, in one pass, of one needle. 1. Preop application of EMLA cream/AMITOP to the donor site 2. Mix 10 mL 1% lidocaine solution with Adrenaline 1:200,000 with 1 vial of Hyaluronidase 1500 units. The mixture is buffered with 1 mL 8.4% sodium bicarbonate to neutralize acidity and minimize pain. 3. Mark out the SSG donor site 4. Using a 27-G long needle (sterican), enter perpendicular to the skin in the middle of the proximal aspect of the donor site. Inject some local anesthetic subdermally, creating a mound. 5. Change the angle of the needle to 180° and continue to inject the remaining anesthetic along one half of the width of the donor site. 6. Using a rolled 4 × 4 swab, apply firm advancing pressure to distribute the mound across the remaining width and length of marked donor site. 7. As the mound advances, the hyluronidase/anesthetic mixture will distribute uniformly across the donor site within the same plane. The skin blanches secondary to the adrenaline during its distribution. The technique described is a fast, reproducible way to improve patient comfort through the elimination of repeated passes of a needle, distributing the anesthetic uniformly across the donor site, and facilitating the acquisition of an SSG of uniform thickness
  136 13 -
Tangential excision of rhinophyma with the disposable razor blade: Simple and cost efficient with aesthetically good results
Marcus Vishal Kiehlmann, Evi M Morandi, Shafreena Kühn, Stefano Spennato, Torsten Schloßhauer, Gabriel Djedovic, Ulrich M Rieger
January-March 2021, 14(1):66-70
Settings and Design: In this two-center study, patients’ charts and photodocumentation were analyzed retrospectively. Materials and Methods: Surgery was performed under general anesthesia with an additional local anesthesia of the affected areas of the nose. We removed the hypertrophic tissue in thin layers with a sterile disposable razor blade under constant visual control of the underlying cartilage and adnexal structures. A dressing with Mepithel and gauzes was applied. Patients presented weekly to monitor the wounds. Follow-up was 1 year. Results: From 2016 to 2019, nine male patients with rhinophyma underwent surgical therapy at AGAPLESION Markus Hospital, Frankfurt am Main, Germany and at the Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Austria. The mean age of the patients was 66 years. Mean time to complete re-epithelization equaled 31.5 days. No recurrences were noted within the follow-up period of 1 year. Patients’ satisfaction was very high. Only one patient had hypertrophic scars at the wing of the nose and another one developed a superficial fistula without connection to the nasal cavity. Conclusion: To the best of our knowledge, this is the first case series describing the use of a disposable razor blade for rhinophyma treatment supporting its efficiency described in previous anecdotal publications. We can highly recommend the technique, as it is cost-efficient and simple and provides excellent aesthetic results.
  132 11 -
Eccrine hidrocystoma: A report of two cases with special reference to dermoscopic features
Pradeep Kumar, Vijay Gandhi, Priti Kumari
January-March 2021, 14(1):112-114
Eccrine hidrocystomas (EHs) are benign tumors, which arise as cystic dilatation of the eccrine sweat duct. The lesions of EH have a chronic course with periodic flares in summer months, associated with exacerbation in sweating. Diagnosis is mainly clinical with histopathology being confirmatory. Dermoscopy is a noninvasive tool, which may confirm diagnosis of EH without subjecting the patient to a biopsy. We report two representative cases of EH, with emphasis on dermoscopic features and which well responded to topical botulinum toxin-like peptide.
  122 17 -
Keystone flap for postburn finger flexion contracture release
Saurabh Gupta, Ravi Kumar Chittoria, Vinayak Chavan, Abhinav Aggarwal, Chirra Likhitha Reddy, Padmalakshmi B Mohan, K Shijina, Imran Pathan
January-March 2021, 14(1):119-122
Flexion contracture of finger is a major cause of disability in postburn patients. Various methods have been described to cover the resultant defect after surgical release of finger flexion contracture. Local flaps are used when there is sufficient tissue available on lateral sides of the finger to recruit into the defect. Keystone flap can be designed on volar aspect of finger to cover the post contracture release defect. Use of local flap reduces need of skin graft and donor site morbidity. Here we discuss a case of postburn finger flexion contracture release using type-3 keystone flap. Postoperative results are satisfactory. Various pros and cons of the technique are discussed. Keystone flap is a new addition to the armamentarium of plastic surgeons for release of postburn flexion contracture of fingers.
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Cosmetic presentations and challenges of body dysmorphic disorder and its collaborative management
Swathi Shivakumar, Mohammad Jafferany, Sneha Sood, V Sushruth
January-March 2021, 14(1):126-131
In recent times, there has been a huge surge in the demand for cosmetology. However, not every patient is an ideal candidate for cosmetic interventions, and this needs to be carefully evaluated at outpatient visit. Various patients have underlying undetected psychiatric co-morbidities which prompt them to seek cosmetic care. One such condition is body dysmorphic disorder in which patients are present with marked anxiety which seems out of proportion to their apparently trivial complaints. These patients are also often unsatisfied with their cosmetic outcome, sometimes turning violent or pressing legal charges against their treatment providers. It is therefore of utmost importance for dermatologists and cosmetic surgeons to be aware of this condition and work in liaison with psychiatrists to provide holistic care to these patients. A literature search of PubMed-indexed journals using keywords “body dysmorphic disorder,” “BDD in dermatology,” and “BDD in cosmetic surgery” was carried out from the year 2000 up to date for this review.
  98 13 -
Innovative indigenous cost-effective bilaminar dermal regeneration template
Koliyath Shijina, Ravi K Chittoria, Vinayak Chavan, Abhinav Aggarwal, Saurabh Gupta, Chirra L Reddy, Padmalakshmi B Mohan, Imran Pathan
January-March 2021, 14(1):104-107
Context: In today’s era of medical advancement, various modalities of treatment options and dressing materials are available for burn wound management. Bilaminar dermal regeneration template is doubtful in developing countries because of its high cost availability and affordability. Aims and Objectives: The aim of this research was to study the use of innovative indigenous cost-effective bilaminar dermal regeneration template in burn raw area. Settings and Design: This study was conducted in the department of plastic surgery in a tertiary care centre from April 2019 to May 2019. Study design is experimental study.
  92 15 -
Innovative cost-effective application of donut dressing in skin grafting
Chirra Likhitha Reddy, Ravi Kumar Chittoria, Konda Sireesha Reddy, Vinayak Chavan, Abhinav Aggarwal, Saurabh Gupta, Padma Lakshmi Bharathi Mohan
January-March 2021, 14(1):123-125
One of the measures for the successful take of a skin graft is the prevention of friction, especially in cases of pressure ulcers in patients with head injury leading to altered sensorium. With existing measures such as the use of a pressure-relieving bed, frequent change of position, etc graft loss is common. Some additional measures are required. This study highlights the role of a donut-shaped ring dressing to protect the skin graft from friction.
  92 14 -
Pursestring technique for treatment of nulliparous congenital inverted nipple
Chetan Satish
January-March 2021, 14(1):78-81
Background: Nipple inversion in nulliparous women is often encountered and is a surgical challenge. The challenge lies in the correction of deformity with minimal marks and also in not damaging the lactiferous ducts, which will interfere with future breastfeeding. Aim: To provide a relatively simple technique, which can be easily performed as an outpatient procedure with minimal complications. Materials and Methods: A total of 11 patients were treated with this technique of which 5 patients had bilateral inverted nipples. Results: We had no recurrence and the follow-up period was of minimal of 1 year. One patient had mild stitch infection, which healed conservatively with antibiotics. Conclusion: The pursestring technique described offers a simple surgical option for the treatment of nulliparous women with nipple inversion.
  90 9 -
Double helix bandage using toilet roll as toe separator to manage intertrigo
Karalikkattil T Ashique, Chakravarthi R Srinivas, Vamshi Krishna, Satyajit Sahu
January-March 2021, 14(1):114-114
  28 2 -
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