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Craniomaxillofacial Trauma &... Dec 2020This is a prospective observational study of 60 consecutive cases with facial scars and contour deformity who underwent structural fat grafting.
STUDY DESIGN
This is a prospective observational study of 60 consecutive cases with facial scars and contour deformity who underwent structural fat grafting.
OBJECTIVES
The aim of the present article is to highlight how fat grafting helps to improve aesthetic and functional outcome in facial scars and contour deformities. It also highlights the factors that need to be considered while planning autologous fat grafting to get better aesthetic results.
METHODS
This is a prospective observational study of 60 consecutive cases with facial scars and contour deformity. The study was conducted from May 2014 to April 2019 in a tertiary care hospital. All the patients were followed up for a minimum period of 1 year from the date of surgery. Assessment of post-operative aesthetic outcome, in terms of satisfaction, was done using the Visual Analogue Scale (VAS), which ranges from 1 to 10 by the patient and operative surgeon.
RESULTS
The mean age was 30.8 9.8 years. Out of 60 patients, 20 patients underwent additional procedure like dermabrasion and collagen dressing to improve aesthetic outcome. Among 60 patients, 24 patients had transient edema and 10 patients had bruising at the recipient site. There were no major donor site complications except pain which was managed conservatively. Mean patient satisfaction score is 7 and mean surgeon satisfaction score is 7.25.
CONCLUSION
Despite the ongoing concerns about survival and longevity of fat grafts and also unpredictability of long-term outcomes, fat grafting has become a very useful surgical tool to improve the quality of facial scars and correct contour deformity. Our series shows excellent outcome both clinically as well as from the patient satisfaction. Future research is warranted in the fields of the adipocyte derived stem cells and to expand the clinical application of fat grafting.
PubMed: 33456702
DOI: 10.1177/1943387520948709 -
Eplasty 2015We recently published a 10-patient case series where free flap donor site reconstruction was performed as a 2-stage procedure using an integrating biodegradable...
INTRODUCTION
We recently published a 10-patient case series where free flap donor site reconstruction was performed as a 2-stage procedure using an integrating biodegradable polyurethane matrix (to form a neodermis), followed by definitive closure with an autologous split-skin graft. Two issues were revealed by this pilot study that led to further modification of the biodegradable temporizing matrix. This involved alterations to the seal thickness and bonding to the foam matrix and the introduction of fenestrations to the seal.
OBJECTIVE
This article documents a second cohort of patients requiring free flap (fibular and radial forearm) donor site reconstruction with this optimized material.
METHODS
The biodegradable temporizing matrix was implanted when the free flap was detached from its donor site. Subsequent integration was monitored closely. Five weeks was the usual time of integration before delamination (seal removal), dermabrasion, and definitive closure with autograft.
RESULTS
Integration was complete and uncomplicated in every case, delamination occurred in 1 piece in 1 action, and subsequent graft take was 100% for every patient. Long-term scar outcomes improved compared with the pilot group. Degradation is complete by 12 months, other than occasional microscopic remnants undergoing phagocytosis.
CONCLUSION
This study has reiterated that the biodegradable temporizing matrix can be implanted into humans, followed by neovascularization and integration. No infection was observed, and split-skin overgrafting was successful and uncomplicated.
PubMed: 26171099
DOI: No ID Found -
International Journal of Surgery Case... Apr 2023Nevus comedonicus (NC) is a rare cutaneous disorder thought to be caused by hamartomatous pilosebaceous tissue proliferation that was first described in 1895. Clinically...
INTRODUCTION
Nevus comedonicus (NC) is a rare cutaneous disorder thought to be caused by hamartomatous pilosebaceous tissue proliferation that was first described in 1895. Clinically NC appears as a group of elevated follicular openings often linearly arrayed, giving the appearance of comedones. NC usually manifests at birth but can also present later during adolescence and rarely in adulthood.
CASE PRESENTATION
A 21-year-old medically healthy single male presented with right-sided chest black papules in comedo distribution with areas of superficial ulcerations and suppurations in periareolar distribution since the age of 16. Histopathological examination showed dilated follicular ostia filled with keratin plug, devoid of the hair shaft, and lined by stratified squamous epithelium with compact hyperkeratosis, focal parakeratosis, and patchy atrophy and acanthosis.
CLINICAL DISCUSSION
Nevus comedonicus often responds effectively to conservative treatment, however some cases need surgery intervention. The patient failed conservative medical and topical treatment, and he was treated by surgical-wide local excision and primary closure of the affected skin with free nipple grafting.
CONCLUSION
Nevus comedonicus (NC) is a rare cutaneous pathology secondary to pilosebaceous apparatus developmental defect that usually manifests at birth and can affect any area of skin; they typically manifest as black papules in comedo distribution. They can present as an isolated cutaneous pathology or as a component of nevus comedonicus syndrome. Different therapeutic approaches were described, including topical retinoids, keratolytic agents, oral retinoids, antibiotic therapy, manual extraction of comedos, dermabrasion, and surgical resection of the lesion.
PubMed: 37001367
DOI: 10.1016/j.ijscr.2023.108021 -
Journal of Cutaneous and Aesthetic... 2021Medical therapies for rhinophyma have been described but these only delay progression. Therefore, surgery is the method of choice. Plenty of modalities have been...
UNLABELLED
Medical therapies for rhinophyma have been described but these only delay progression. Therefore, surgery is the method of choice. Plenty of modalities have been described including cold-knife surgery, electrosurgery, hydrosurgery, laser-assisted treatments, and dermabrasion.
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.
PubMed: 34084011
DOI: 10.4103/JCAS.JCAS_139_20 -
JAMA Dermatology Mar 2018Epidermal cell suspension (ECS) and follicular cell suspension (FCS) are successful surgical modalities for the treatment of stable vitiligo. However, repigmentation in... (Comparative Study)
Comparative Study Randomized Controlled Trial
IMPORTANCE
Epidermal cell suspension (ECS) and follicular cell suspension (FCS) are successful surgical modalities for the treatment of stable vitiligo. However, repigmentation in generalized and acrofacial vitiligo and over acral or bony sites (eg, elbows, knees, iliac crests, and malleoli), which are difficult to treat, is challenging.
OBJECTIVE
To study the efficacy of transplanting a combination of autologous, noncultured ECS and FCS (ECS + FCS) compared with ECS alone in stable vitiligo.
DESIGN, SETTING, AND PARTICIPANTS
A prospective, observer-blinded, active-controlled, randomized clinical trial was conducted at a tertiary care hospital, with treatment administered as an outpatient procedure. Thirty participants who had stable vitiligo with symmetrical lesions were recruited between October 18, 2013, and October 28, 2016. All of the lesions were resistant to medical modalities with minimum lesional stability of 1 year. Intent-to-treat analysis was used.
INTERVENTIONS
ECS + FCS was prepared by mixing equal amounts (in cell number) of FCS with ECS. After manual dermabrasion, ECS was applied to 1 lesion and ECS + FCS was applied to the anatomically based paired lesion of the same patient. No adjuvant treatment was given.
MAIN OUTCOMES AND MEASURES
Patients were followed up at 4, 8, and 16 weeks by a blinded observer and extent of repigmentation, color match, pattern of repigmentation, patient satisfaction and complications were noted. Both the visual and the computerized image analysis methods were used for outcome assessment. Cell suspensions were assessed post hoc for OCT4+ stem cell counts using flow cytometry; expression of stem cell factor and basic fibroblast growth factor was evaluated using quantitative relative messenger RNA expression.
RESULTS
Of the 30 patients included in the study, 18 (60%) were women; mean (SD) age was 23.4 (6.4) years. Seventy-four percent of the lesions (62 of 84) were difficult-to-treat vitiligo. ECS + FCS showed superior repigmentation outcomes compared with ECS: extent (76% vs 57%, P < .001), rapidity (48% vs 31%, P = .001), color match (73% vs 61%, P < .001), and patient satisfaction (mean [SD] patient global assessment score, 23.30 [6.89] vs 20.81 [6.61], P = .047). Melanocyte stem cell counts (2% in ECS + FCS vs 0.5% in ECS) as well as expression of basic fibroblast growth factor (11.8-fold) and stem cell factor (6.0-fold) were higher in ECS + FCS suspension (P<.05 for both).
CONCLUSIONS AND RELEVANCE
The findings from this study establish ECS + FCS as a novel approach in vitiligo surgery for attaining good to excellent repigmentation in a short period with good color match, even in difficult-to-treat vitiligo.
TRIAL REGISTRATION
ctri.nic.in Identifier: CTRI/2017/05/008692.
Topics: Adolescent; Adult; Autografts; Cell Count; Cell Transplantation; Child; Epidermal Cells; Female; Fibroblast Growth Factor 2; Hair Follicle; Humans; Male; Melanocytes; Patient Satisfaction; Prospective Studies; Single-Blind Method; Skin Pigmentation; Transplantation, Autologous; Vitiligo; Young Adult
PubMed: 29387874
DOI: 10.1001/jamadermatol.2017.5795 -
Frontiers in Pediatrics 2023To investigate the therapeutic effect of clitoris exposure + episioplasty + dermabrasion + platelet-rich plasma (PRP) injection + chemexfoliation on vulvar lichen...
INTRODUCTION
To investigate the therapeutic effect of clitoris exposure + episioplasty + dermabrasion + platelet-rich plasma (PRP) injection + chemexfoliation on vulvar lichen sclerosus (VLS).
METHODS
Twenty children with VLS (under 14 years old) at our hospital from July 2020 to November 2022 were enrolled and treated with clitoris exposure + episioplasty + dermabrasion + PRP injection + chemexfoliation. Additionally, symptomatic changes and improvements in signs were recorded.
RESULTS
Significant therapeutic effects were achieved in all children enrolled in this study. The Cattanco score was 8.02 ± 1.22 points before surgery, 2.21 ± 0.70 points 3 months after surgery, and 2.61 ± 0.59 points 6 months after surgery, demonstrating that the score after surgery was significantly lower than that before surgery ( < 0.05). Mild complications (one case of mild vulvar swelling, one case of minor bleeding, and one case of superficial ulcer) were observed in three children after surgery, with an overall complication incidence of 15%; all complications were improved after the intervention, and no severe adverse reactions were observed. Recurrence was observed in one child (5%) 6 months after surgery.
CONCLUSION
Clitoris exposure + episioplasty + dermabrasion + PRP injection + chemexfoliation is an effective approach for the treatment of VLS.
SYSTEMATIC REVIEW REGISTRATION
https://www.chictr.org.cn/searchproj.html, identifier: ChiCTR2100054787.
PubMed: 38111623
DOI: 10.3389/fped.2023.1276786 -
Journal of Cutaneous and Aesthetic... 2021Vitiligo involving the angle of lip is a therapeutically challenging site because of the small and delicate area, high mobility, and lack of hair follicles. Dermabrasion...
Vitiligo involving the angle of lip is a therapeutically challenging site because of the small and delicate area, high mobility, and lack of hair follicles. Dermabrasion combined with topical 5-fluorouracil cream has shown promising results in various studies involving different sites. Here we present a novel technique of using radiofrequency cautery for abrasion of epidermis followed by application of 5-fluorouracil cream. This technique has the advantage of being simple, easy, cost-effective with less downtime. A single session can yield excellent pigmentation in small areas such as the angle of lip.
PubMed: 35283607
DOI: 10.4103/JCAS.JCAS_187_20 -
The British Journal of Dermatology Mar 2020Spontaneous lightening of congenital melanocytic naevi (CMN) has not been studied systematically. Final colour is considered an important outcome after superficial...
BACKGROUND
Spontaneous lightening of congenital melanocytic naevi (CMN) has not been studied systematically. Final colour is considered an important outcome after superficial removal techniques such as curettage, dermabrasion or laser ablation, and is often compared with colour at birth.
OBJECTIVES
To quantify the natural history of CMN lightening over time, and explore phenotypic and genotypic predictors of colour change.
METHODS
A longitudinal cohort study was undertaken of 110 patients with CMN (mean follow-up 5·3 years). Accurate colour-space measurements were taken from professional serial photographs of CMN and normal skin. Changes in colour over time were modelled using multiple logistic regression, against phenotypic and genotypic variables.
RESULTS
Lightening of CMN was significantly associated with lighter normal skin colour (P < 0·001) and with MC1R variant alleles (red/blonde hair gene) (P < 0·001), but not with CMN colour in the first 3 months of life, NRAS genotype or projected adult size of CMN. Importantly, the final colours of adjacent treated and untreated areas of CMN were indistinguishable.
CONCLUSIONS
Final CMN colour in childhood is related to the genetically determined skin colour of the individual, is unrelated to the colour of CMN at birth, and is unaffected by superficial removal. What's already known about this topic? Final colour of congenital melanocytic naevi (CMN) is considered an important outcome after superficial removal techniques such as curettage, dermabrasion or laser ablation, and is often compared with colour at birth. The phenomenon of spontaneous lightening in CMN, in which naevi lighten gradually and sometimes dramatically during childhood, has been described but not systematically studied. What does this study add? Final CMN colour in childhood is significantly associated with the individual's normal skin colour, and with MC1R genotype, and is therefore genetically determined. Final CMN colour is not predictable from CMN colour in the first 3 months of life. Superficial removal techniques do not alter the final colour of CMN.
Topics: Adult; Color; Humans; Infant, Newborn; Longitudinal Studies; Nevus, Pigmented; Skin Neoplasms; Skin Pigmentation
PubMed: 31120141
DOI: 10.1111/bjd.18149 -
Ear, Nose, & Throat Journal 2018Rhinophyma is a disfiguring end-stage manifestation of acne rosacea. It is characterized by a painless hyperplasia of the sebaceous glands and connective tissues of the...
Rhinophyma is a disfiguring end-stage manifestation of acne rosacea. It is characterized by a painless hyperplasia of the sebaceous glands and connective tissues of the nose. Numerous surgical modalities-including scalpel surgery, dermabrasion, CO laser ablation, and electrocautery-have been reported with varying results. We describe our experience with using a microdebrider to treat 2 patients-a 65-year-old man and a 74-year-old man-who presented with rhinophyma. The instrument we used was the Medtronic Straightshot M4 Microdebrider. Using a low revolution speed, we easily excised the bulky superficial tissue. At higher revolution speeds with the use of a small shaver tip, we were able to achieve delicate contouring of the nasal tip and ala without causing scarring. Postoperatively, both patients exhibited an excellent cosmetic outcome and expressed a high degree of patient satisfaction. We conclude that the microdebrider is an excellent surgical tool for treating rhinophyma lesions. Its ease of use and its availability at most surgical centers makes it a favorable surgical option.
Topics: Aged; Debridement; Humans; Male; Nose; Rhinophyma
PubMed: 29493731
DOI: 10.1177/0145561318097001-210 -
Journal of Cutaneous and Aesthetic... 2017Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13--retinoic acid) states that...
BACKGROUND
Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13--retinoic acid) states that the procedures should not be performed. The recommendations in standard books and drug insert require discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. These recommendations have been followed for over two decades despite little evidence for the stated increased risk of scarring.
OBJECTIVE
The Association of Cutaneous Surgeons (I) constituted a task force to review the evidence and to recommend consensus guidelines regarding the safety of skin procedures, including resurfacing, energy-device treatments, and dermatosurgical procedures in patients with concurrent or recent isotretinoin administration.
MATERIALS AND METHODS
Data were extracted from the literature through a PubMed search using the keywords "isotretinoin," "safety," "scarring," "keloids," "hypertrophic scarring," and "pigmentation." The evidence was then labeled and circulated to all members of task force for review.
RESULTS
The task force is of the opinion that there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued. The task force concludes that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration.
PubMed: 29491653
DOI: 10.4103/JCAS.JCAS_110_17