Cosmetic Results (cosmetic + result)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Cosmetic Results

  • excellent cosmetic result
  • good cosmetic result


  • Selected Abstracts


    Surgical Treatment of Ingrown Toenail without Matricectomy

    DERMATOLOGIC SURGERY, Issue 1 2008
    BERNARD NOĖL MD
    BACKGROUND Partial excision of the nail matrix (matricectomy) is generally considered necessary in the surgical treatment of ingrown toenail. Recurrences may occur, however, and poor cosmetic results are frequently observed. OBJECTIVE The objective is to present a new surgical procedure for ingrown toenail with complete preservation of the nail matrix. METHODS Twenty-three patients with ingrown toenail were included in this study. The surgical excision was performed 1 week after the completion of treatment of the initial infection. A large volume of soft tissue surrounding the nail plate was removed under local anesthesia. No matrix excision was performed. RESULTS Short-term results were excellent. No recurrences or severe complications were observed during the minimum 12-months follow-up period. Cosmetic results were remarkable. CONCLUSIONS Ingrown toenail results from the compression of the lateral nail folds on the nail plate. This study shows that ingrown toenail can be surgically treated without matricectomy. A large volume of soft tissue surrounding the nail plate should be removed to decompress the nail and reduce inflammation. Cosmetic results are excellent and superior to the classical Emmert plasty. Postoperative nail dystrophies and spicule formation are not observed. The main advantage of this surgical approach is the complete preservation of the anatomy and function of the nail to improve both therapeutic and cosmetic results. [source]


    Evidence-Based Review of the Use of Cryosurgery in Treatment of Basal Cell Carcinoma

    DERMATOLOGIC SURGERY, Issue 6 2003
    Agnieszka Kokoszka MD
    Background. Cryosurgery has been used to treat basal cell carcinoma (BCC), and it has many technical advantages over other methods. It is therefore important to establish its efficacy as a treatment for BCC. Objective. To review systematically the body of literature reporting on the efficacy of cryosurgery of BCC in terms of recurrence rates and cosmetic results. Methods. A review is given of MEDLINE, EMBASE, CancerLit, and the Cochrane Database of Systematic Reviews for studies that examined cryosurgery in treatment of BCC patients. Results. We found 13 noncontrolled prospective studies and 4 randomized clinical trials comparing cryosurgery to other methods of treatment for BCC. Because of the inability to double blind or placebo control treatment of BCC, none of the studies met criteria for A or B grade evidence, as defined by Sackett. Therefore, all studies were assigned grade C. Conclusions. According to the best evidence, recurrence rates of BCC treated with cryosurgery are low (less than 10%). Except in one study, recurrence rates are calculated based on clinical, rather than histologic diagnosis, which may cause the rates to appear somewhat lower than they actually are, especially with a short follow-up period. Cosmetic results of cryosurgery treatment reported in literature are described as good by most investigators. Overall, there are sufficient data to consider cryosurgery as a reasonable treatment for BCC. There are no good studies, however, comparing cryosurgery with other modalities, particularly with Mohs surgery, excision, or electrodesiccation and curettage so that no conclusion can be made whether cryosurgery is as efficacious as other methods. Also, there is no evidence on whether curetting the lesions before cryosurgery affects the efficacy of treatment. [source]


    Long-term results after reconstruction of full thickness scalp defects with a dermal regeneration template

    JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 5 2010
    J Faulhaber
    Abstract Objective, Large scalp defects in which the pericranium has to be resected can be reliably reconstructed using Integra®. In the present study, we retrospectively analysed the long-term outcome of our patients. Methods, Nineteen patients were included who had received Integra® dermal regeneration template for treatment of full thickness scalp defects after resection of various malignant tumours. All patients were followed up with a mean follow-up time of 31 months (14,72). Results, All transplants were on almost equal levels with the surrounding skin. Cosmetic results were acceptable and scars were stable. Nodal ultrasound status was negative in all patients. During the follow-up period of up to 72 months, no local recurrences were observed. One patient with a leiomyosarcoma received radiotherapy after transplantation. In the irradiated area, multiple small regular-shaped round ulcerations and later on partial necrosis of the transplant occurred when the patient developed renal failure 29 months after the initial operation. Five patients died of disease not related to the primary skin tumour. All other patients are alive and free of disease without any complications. Conclusion, After reconstruction of full thickness scalp defects with Integra®, the cosmetic results are appealing and we observed no local recurrences during the follow-up period. [source]


    Multiple nodules of the scrotum: histopathological findings and surgical procedure.

    JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 6 2006
    A study of five cases
    Abstract Background, Multiple nodules of the scrotum are uncommonly reported. Their origin is controversial. Treatment is always surgical but the best procedure is still to be determined. Materials and methods, Five new cases are reported with description of the histopathological findings and surgical procedure. Results, Nodules of the scrotum were more frequent in patients with dark skin suggesting an ethnic susceptibility. No other predisposing factors were noted. Screening for disturbances of phosphate or calcium balance was negative. The following histopathological findings were observed: non-calcified epidermoid cysts (3 patients), calcified epidermoid cysts (1 patient) and nodular calcifications without epithelial or glandular structures (1 patient). Subtotal excisions of the scrotum wall using tumescent anaesthesia were performed in all patients without any significant complications. Cosmetic results were excellent. No new lesions were observed during the 1-year follow-up period. Conclusions, Most cases of multiple nodules of the scrotum are due to non-calcified epidermoid cysts. The term scrotal calcinosis is therefore probably abusively used by many authors. Some cases of nodular calcifications may be due to dystrophic calcification of epidermoid cysts, but calcifications may also occur without any visible epithelial or glandular structure. Subtotal excision of the scrotum wall is a safe and effective surgical procedure to treat multiple nodules of the scrotum. Cosmetic results are excellent and recurrences are rare. [source]


    Routine double treatments of superficial basal cell carcinomas using aminolaevulinic acid-based photodynamic therapy

    BRITISH JOURNAL OF DERMATOLOGY, Issue 6 2000
    J.C. Haller
    Background,Superficial basal cell carcinomas of the skin (sBCC) often respond poorly to single-treatment aminolaevulinic acid-based photodynamic therapy (ALA,PDT), with a number of reports indicating a relapse rate of 50% or more. Objectives,To determine whether a second treatment at seven days can improve the response. Methods,Twenty-six lesions were treated twice with ALA,PDT, with an interval of 7 days between the two treatment sessions. Results,We observed a complete response rate of 100% 1 month after treatment. Only one lesion relapsed (16 months post-PDT), a relapse rate of 4% (median follow up 27 months; range 15,45 months). Cosmetic results were excellent. Conclusions,We consider routine double treatments with ALA,PDT to be an effective approach to the management of sBCC, particularly those located in anatomically difficult, or cosmetically sensitive, sites. [source]


    A prospective study of concurrent cyclophosphamide/methotrexate/5-fluorouracil and reduced-dose radiotherapy in patients with early-stage breast carcinoma

    CANCER, Issue 7 2004
    Jennifer R. Bellon M.D.
    Abstract BACKGROUND Concurrent administration of chemotherapy and radiotherapy has the potential advantage of delaying neither treatment and providing radiation sensitization. However, the optimal approach to concurrent treatment in women with early-stage breast carcinoma remains undefined. We present updated results of a prospective protocol of concurrent cyclophosphamide/methotrexate/5-fluorouracil (CMF) and reduced-dose radiotherapy, focusing on tumor control and patient tolerance. METHODS One hundred twelve women with AJCC Stage I or Stage II breast carcinoma with 0,3 positive axillary lymph nodes were enrolled in a prospective single-arm study of concurrent CMF and reduced-dose radiotherapy (39.6 gray [Gy] to the whole breast, 16-Gy boost). A high proportion of women had risk factors associated with an increased risk of local disease recurrence, including age < 40 (32%), close or positive margins (37%), or lymphatic/vascular invasion (51%). The median follow-up period was 94 months. RESULTS The 5-year overall survival rate was 94%. By 60 months, 5 patients (4%) experienced local disease recurrence and 19 patients (17%) experienced distant metastasis. There were no isolated regional lymph node recurrences. Local disease recurrence occurred in 1 of 25 patients (4%), 1 of 16 patients (6%), and 3 of 70 patients (4%) with positive, close (< 1 mm), and negative margins, respectively. One patient developed acute myelogenous leukemia. An additional patient developed Grade 2 pneumonitis. Cosmetic results were not recorded uniformly for all patients and therefore could not be reliably analyzed. CONCLUSIONS Concurrent CMF and reduced-dose radiotherapy resulted in a low level of late toxicity and excellent local tumor control, despite the large proportion of patients with substantial risk factors for local disease recurrence. Future studies of concurrent regimens, particularly in patients at high risk of local disease recurrence, are warranted. Cancer 2004;100:1358,64. © 2004 American Cancer Society. [source]


    Equal Cosmetic Outcomes with 5-0 Poliglecaprone-25 Versus 6-0 Polypropylene for Superficial Closures

    DERMATOLOGIC SURGERY, Issue 7 2010
    LAURA B. ROSENZWEIG MD
    BACKGROUND Cutaneous sutures should provide an aesthetically pleasing result. After placing subcutaneous sutures, enough absorbable suture often remains for the superficial closure. Mohs surgeons often use a nonabsorbable suture to close the superficial layer to obtain cosmetically elegant results, but using this additional suture is less cost effective than using the remaining absorbable suture. OBJECTIVES To compare the cosmetic results of simple running sutures using an absorbable suture material (5-0 poliglecaprone-25) with those of a nonabsorbable suture (6-0 polypropylene) in primary closures of suitable facial Mohs defects. MATERIALS AND METHODS Fifty-two patients with 57 facial Mohs surgery defects appropriate for multilayer primary repair had the defects prospectively randomized into a side-by-side comparison. After closure of the deep layers with 5-0 poliglecaprone-25 sutures, half of the wound was closed with a 5-0 poliglecaprone-25 simple running suture, and the other half of the wound was closed with a 6-0 polypropylene simple running suture. The investigators blindly determined the cosmetically superior side of the closure at 1 week and 4 months after suture removal. RESULTS Forty-four patients (48 total defects) completed the study. At the 4-month follow-up, 85% (41/48) did not show any difference between poliglecaprone-25 and polypropylene, 4% (2/48) had better outcomes with poliglecaprone-25, and 10% (5/48) had better outcomes with polypropylene. There was no statistically significant cosmetic difference between the two closure types. Wound complications such as infection, hematoma, and dehiscence did not occur in any of the patients. CONCLUSION In primary closures of facial defects, using 5-0 poliglecaprone-25 or 6-0 polypropylene for the superficial closure did not affect the cosmetic result. Therefore, 5-0 poliglecaprone-25 provides a comparable and cost-effective alternative to nonabsorbable sutures for epidermal approximation in layered closures. The authors have indicated no significant interest with commercial supporters. [source]


    The Efficacy of Electrosurgery and Excision in Treating Patients with Multiple Apocrine Hidrocystomas

    DERMATOLOGIC SURGERY, Issue 4 2001
    Somesh Gupta MD
    Background. Apocrine hidrocystomas are adenomatous cystic proliferations of the apocrine glands. They typically occur as solitary lesions, though rarely may occur as multiple lesions. Management of multiple hidrocystomas can be difficult, particularly if they are large. Surgical modalities may be required for effective therapy. Objective. To compare the results of electrosurgery and excision in treating multiple apocrine hidrocystomas. Methods. A 50-year-old man presented with multiple apocrine hidrocystomas ranging in size from 1 to 12 mm. The lesions were located over the periorbital skin, cheeks, and pinnae. Excision and electrodessication were utilized for therapy. At a 1-year follow-up, the patient was evaluated for recurrences and cosmetic result. Results. There were no recurrences until 1 year after surgery. In the areas treated with electrodessication, no visible scars were identified. In the areas treated with excision, localized scars were observed. Conclusions. Both electrodessiation and excision are effective therapies for multiple apocrine hidrocystomas. We suggest that tumors less than 1 cm be treated with electrodessication and lesions greater than 1 cm with excision. [source]


    Donor Harvesting: A New Approach to Minimize Transection of Hair Follicles

    DERMATOLOGIC SURGERY, Issue 4 2000
    Damkerng Pathomvanich MD
    Background. There are several methods for harvesting donor hairs, including punch excision, single-bladed knife excision, and multibladed knife excision. All of these procedures are blind and thus result in transection of hair follicles. Transection of hair follicles during harvesting results in fewer follicles being available for transplantation, detrimentally affecting the final cosmetic result. Objective. To explore a new method of donor hair harvesting called "donor dissecting." This new procedure is an open technique because hair follicles are directly visualized during the harvesting process. Methods. The technique of donor dissecting utilizes a #15 scalpel blade to excise the donor hair ellipse from the occiput while maintaining meticulous hemostasis. This enables individual hair follicles to be visualized and protected from transection during the harvesting process. Once the donor ellipse is harvested, it is then further divided into individual mini- and micrografts using direct visualization of individual follicles to again prevent transection. Results. The technique of donor dissecting was utilized in 50 consecutive hair transplant patients. Utilizing this new technique, only 1.9% of hair follicles in the donor ellipse were transected during the harvesting process. The dissection of the donor ellipse 1.2% follicles being transected in the graft cutting process. Combining the donor dissection technique with dissection of the individual grafts, we were able to transect 1.59% of hair follicles harvested for transplantation. Conclusion. The technique of donor dissection minimizes the transection of hair follicles in the donor hair harvesting phase of hair transplantation. This technique is superior to the blind methods of donor harvesting which have been plagued by the problem of hair follicle transection. [source]


    Surgical Management of Stable Vitiligo: A Review with Personal Experience

    DERMATOLOGIC SURGERY, Issue 3 2000
    Sharad Mutalik MB
    Background. Various modalities are available for surgical management of stable, localized patches of vitiligo, which are resistant to conventional medical treatment. Cutaneous surgeons often struggle to select among various methods of surgical treatment that include camouflage tattooing, melanocyte transplants, excision, and melanocyte culture. The advantages, disadvantages, and limitations of all the available modalities are reviewed. Objective. The purpose of this review is to find out if any guidelines can be drawn regarding the surgical management of stable vitiligo. Methods. This article is based on a review of the medical literature and the author's personal experience over the last decade. Results. It is difficult to draw any fixed guidelines from this review. Treatment must be individualized depending upon the site and the extent of involvement. Conclusion. Although the retrospective nature of this article limits its validity, discussing the various therapeutic options is of value as continuing medical education. Surgical treatment may be individualized to obtain the best possible cosmetic result. [source]


    Surgical therapies, part II: flip-top transplants in vitiligo

    DERMATOLOGIC THERAPY, Issue 1 2001
    Thomas W. McGovern
    ABSTRACT: The flip-top transplantation (FTT) method provides an important option for the treatment of depigmentation. It enables any physician to treat stable areas of depigmentation using equipment that is readily available and easy to use. To date, this method has resulted in the spread of pigmentation from each graft and has caused no visible scarring. FTT is best suited for treating localized areas of stable depigmentation where the cosmetic result is a priority. [source]


    Current concepts in hypospadias surgery

    INTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2008
    Yutaro Hayashi
    Abstract: Anatomical anomalies in hypospadias are an abnormal ventral opening of the urethral meatus, abnormal ventral curvature of the penis and abnormal distribution of the foreskin around the glans with a ventrally deficient hooded foreskin. The techniques of hypospadias surgery continue to evolve. The current standard of care for hypospadias repair includes not only a functional penis adequate for sexual intercourse and urethral reconstruction offering the ability to stand to urinate, but also a satisfactory cosmetic result. Tubularized incised plate repair has been the mainstay for distal hypospadias. In cases of proximal hypospadias, one-stage repairs such as the Duckett repair or the Koyanagi repair have been well established, while two-stage repairs remain important alternatives. Whether dorsal plication or ventral lengthening should be used to correct penile curvature is still controversial, and long-term results are required. Efforts have been made in this decade to improve cosmetic appearance, constructing a slit-like meatus or performing foreskin reconstruction, and to prevent onerous complications. [source]


    Endoscopic Versus Conventional Radial Artery Harvest,Is Smaller Better?

    JOURNAL OF CARDIAC SURGERY, Issue 4 2006
    Oz M. Shapira M.D.
    Methods: Data were prospectively collected on 108 consecutive patients undergoing isolated CABG with ERH, and compared to 120 patients having conventional harvest (CH). Follow-up was achieved in 227 patients (99%). At the time of follow-up the severity of motor and sensory symptoms, as well as cosmetic result in the harvest forearm, were subjectively graded using a 5-point scale. Grade 1,high intensity deficits, poor cosmetic result. Grade 5,no deficits, excellent cosmetic result. Results: Hospital mortality, myocardial infarction, and stroke rates were similar between the groups. Follow-up mortality, reintervention rate, and average angina class were also similar. Harvest time was longer in the ERH group (61 ± 24 min vs. 45 ± 11 min, p < 0.001). Three patients in the ERH group were converted to CH and one radial artery was discarded. There were no vascular complications of the hand in either group. Average score of motor (ERH 4.4 ± 0.9, CH 4.2 ± 1.0) or sensory symptoms (ERH 3.7 ± 1.1, CH 3.8 ± 1.2) were similar. In the CH group sensory deficits were observed in the distribution of both the lateral antebrachial cutaneous and the superficial radial nerves (SRN). In contrast, sensory deficits in the ERH group were limited to the distribution of the SRN. Cosmetic result score was higher in the ERH group (ERH 4.2 ± 1.0, CH 3.1 ± 1.4, p < 0.0001). Conclusions: ERH is safe. It is technically demanding with a significant learning curve. Motor and sensory symptoms are not completely eliminated by using a smaller incision, but cosmetic results are clearly superior. [source]


    Surgical approach to benign small papular and dome-shaped melanocytic naevi on the face

    JOURNAL OF COSMETIC DERMATOLOGY, Issue 3-4 2003
    U Tursen
    Summary Patients frequently request removal of benign papular and dome-shaped naevi for cosmetic or functional reasons. Melanocytic naevi can be removed by elliptical, round, punch or shave excision or destroyed using electrodessication or cryotherapy. Total elliptical excision is probably the most widely used method of removal. If malignancy is suspected, adequate specimens for histological interpretation are required. When malignancy is not suspected, the cosmetic result becomes the first priority. Smaller incisions minimize tissue trauma and so give cosmetically superior results. Round excision has been recommended for the removal of moles but has not been widely practised. Round excision and punch excision may be better alternatives than conventional fusiform excision of benign dome-shaped or papular naevi of the face, as more tissue is preserved. Shave excision of naevi may be preferable to elliptical excision in sites where the incidence of hypertrophic scarring is high, as preservation of some thickness of the dermis may result in a more acceptable scar or even avoid a scar entirely. Expedient and simple surgery with excellent cosmetic results can be accomplished by the use of punches. Cryotherapy with cutting or curetting and electrodesiccation combined with shaving have been described. Round excision may be a better alternative to conventional fusiform or shave excision of benign papular or dome-shape nevus of the face because it leaves an almost imperceptible scar. In this technique, less skin is excised and histopathological examination can be done. [source]


    Surgical Excision of Pedunculated Supernumerary Digits Prevents Traumatic Amputation Neuromas

    PEDIATRIC DERMATOLOGY, Issue 2 2003
    Geoffrey E. Leber
    The first group consisted of three patients who had among them five traumatic amputation neuromas. In each case these lesions resulted from primary suture ligation of accessory digits in infancy. Secondary surgical excision of the vestigial digit with high ligation and retraction of the accompanying nerve tissue was required in all cases. The second group consisted of six patients who had 12 pedunculated supernumerary digits. Primary surgical excision of these digits was performed with high transection and retraction of the accompanying accessory digital nerve. All patients in this group had excellent cosmetic results with no postoperative neuroma formation. Adult family members who had undergone suture ligation of similar supernumerary digits in infancy accompanied seven of the nine patients in this series. On careful examination, each of these family members had signs and symptoms attributable to traumatic amputation neuromas. We feel identification and high transection of the accessory digital nerve is essential in the treatment of pedunculated supernumerary digits. This treatment prevents traumatic amputation neuromas and yields a better cosmetic result than the traditional method of suture ligation in infancy. [source]


    Retrograde Weight Implantation for Correction of Lagophthalmos,

    THE LARYNGOSCOPE, Issue 9 2004
    Chuan-Hsiang Kao MD
    Abstract Objectives: Gold weight implantation is the most commonly used method for surgical correction of paralytic lagophthalmos. Numerous techniques for placement of the weight have been described, yet complications with these methods continue to occur (implant migration or extrusion, wound infection, failure to correct the lagophthalmos, and excessive postoperative ptosis). We developed a retrograde, postlevator aponeurosis method for implantation to improve the placement and fixation of the weight. This study describes the rationale, technique, and surgical outcome of the retrograde approach. Study Design: Retrospective analysis. Methods: Data maintained and collected on 25 consecutive cases of retrograde upper lid weight implantation for paralytic lagophthalmos. Pre- and postoperative photographs were obtained, and patients were followed for at least 6 months. All procedures were performed by or under the direction of a single surgeon at tertiary academic medical centers (University of California, San Diego and University of Zurich, Switzerland). Results: Twenty-five consecutive patients were evaluated, 16 male and 9 female, ranging in age from 27 to 86 years. There were no surgical failures or perioperative complications and no instances of implant migration or extrusion. One patient developed a delayed infection requiring removal of the implant, and one patient required replacement of the gold weight with a platinum chain implant to better fit the contour of her eyelid. Conclusions: Retrograde implantation allows more accurate placement of the weight while creating a permanent circumferential seal for fixation. The procedure is minimally invasive, less traumatic than previous methods, and produces an excellent cosmetic result. The efficacy has been demonstrated in the outcome of the 25 cases described in this study. [source]


    Long-Term Results of Endonasal Sinus Surgery in Sinonasal Papillomas

    THE LARYNGOSCOPE, Issue 9 2003
    Marcel Kraft MD
    Abstract Objective To assess the value of endonasal sinus surgery in the management of sinonasal papillomas. Study Design Retrospective study including 43 patients operated on for sinonasal papilloma in a long-term follow-up. Methods In 26 cases (60%) an endonasal approach, in eight cases (19%) an external approach, and in four cases (9%) a combined procedure was performed to remove these tumors. Five septal lesions (12%) were resected under direct vision. The original sections and charts of all patients were reviewed to assess clinical data. Follow-up information was available for 42 of our patients (98%) with a mean follow-up of 62 months. Results Histologic examination revealed 34 cases of inverted papilloma (79%), five cases of exophytic papilloma (12%), and four cases of columnar cell papilloma (9%). Malignancy occurred in 4 of 43 patients (9%), and recurrences developed in 8 of 42 patients (19%). Two of these recurrences happened after endoscopic sinus surgery (two inverted papillomas), three after lateral rhinotomy (three inverted papillomas), one after a combined procedure (one inverted papilloma), and two after simple resection (two exophytic papilloma). Conclusions In keeping with our experience, the endonasal endoscopic approach, often in combination with a medial maxillectomy, is favored for the treatment of sinonasal papilloma because of a lower recurrence rate and a better cosmetic result. In some larger tumors and lesions in difficult locations, better visualization can be obtained by a combined external and endonasal approach. [source]


    Laparoscopic Live Donor Nephrectomy with Vaginal Extraction: Initial Report

    AMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2010
    M. E. Allaf
    The recent decrease in the total number of living kidney transplants coupled with the increase in the number of candidates on the waiting list underscores the importance of eliminating barriers to living kidney donation. We report what we believe to be the first pure right-sided laparoscopic live donor nephrectomy with extraction of the kidney through the vagina. The warm ischemia time was 3 min and the renal vessels and ureter of the procured kidney were of adequate length for routine transplantation. The donor did not receive any postoperative parenteral narcotic analgesia, was discharged home within 24 h and was back to normal activity in 14 days. The kidney functioned well with no complications or infections. Laparoscopic live donor nephrectomy with vaginal extraction may be a viable alternative to open and standard laparoscopic approaches. Potential advantages include reduced postoperative pain, shorter hospital stay and convalescence and a more desirable cosmetic result. These possible, but yet unproven, advantages may encourage more individuals to consider live donation. [source]


    Use of adhesive surgical tape with the absorbable continuous subcuticular suture

    ANZ JOURNAL OF SURGERY, Issue 8 2003
    Jeremy D. Kolt
    Background: The absorbable continuous subcuticular suture is frequently used to close surgical incisions where the aim is healing by primary intention. A form of adhesive surgical tape is commonly also placed over the wound but this combination closure seems to have its development based on anecdotal, rather than experimental evidence. The present study reviews the scientific literature on the development of sutureless wound closure and presents the current evidence for the use of combination wound closure. Methods: Review was undertaken of the medical literature using the PubMed Internet database and cross-referencing major ­articles on the subject. The following combinations of key words were searched: skin closure, wound closure, suture technique, sutureless, adhesive tape, op-site, staples, subcuticular suture, complication, infection and scars. Results: Taped closure alone has advantages of lower wound infection rates and greater wound tensile strength, but disadvantages of epidermal reaction, skin edge inversion, doubtful safety and time required for meticulous surgical technique. The use of the continuous absorbable subcuticular suture allows accurate skin edge approximation, which increases the safety margin. The combination closure has a slightly superior cosmetic result to sutureless techniques but no study has been performed to compare the results of combination subcuticular suture and tape, with tape or subcuticular suture alone. Conclusions: There is no evidence in the scientific literature to justify or support the practice of closing a surgical wound with both subcuticular suture and adhesive surgical tape. [source]


    Religious circumcision under local anaesthesia with a new disposable clamp

    BJU INTERNATIONAL, Issue 6 2001
    R.F. Schmitz
    Objective To compare the results using a new disposable clamp (the Taraklamp Circumcision Device®, TCD, Taramedic Europe BV, Bilthoven, The Netherlands), used since 1998 in one clinic, and the conventional dissection technique (CDT) in another clinic, for religious circumcision in infants. Subjects and methods The TCD and CDT were compared prospectively; the duration of the procedure, complications and postoperative pain were recorded. The cosmetic result and the degree to which the parents were satisfied were evaluated after 6 weeks. After obtaining informed consent, 275 boys were included in the study (median age 3 years). Results The median operative duration was 8 min less for the TCD (15 vs 7 min; P < 0.001). There was no difference in complication rate (bleeding in one vs two; infection in two vs three) and postoperative pain was comparable in both groups. The cosmetic results were better for the TCD group (P < 0.001). The parents' satisfaction score for the procedure was equal in the groups, at 8, on a scale of 1 (very bad) to 10 (extremely good). Conclusion A religious circumcision outside the hospital with the TCD is quicker and leads to a better cosmetic result than with the CDT, without increasing morbidity. [source]


    Randomized clinical trial of single-incision laparoscopic cholecystectomy versus minilaparoscopic cholecystectomy

    BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2010
    P.-C. Lee
    Background: Transumbilical single-incision laparoscopic cholecystectomy (SILC) and minilaparoscopic cholecystectomy (MLC) are both increasingly being used to treat symptomatic gallstones. The present study compared SILC and MLC with respect to outcome in a prospective randomized trial. Methods: Seventy patients with symptomatic cholelithiasis were randomized to SILC or MLC (35 in each group). The primary outcome measure was postoperative pain. Secondary outcomes were duration of operation, complications, postoperative analgesic requirements, length of hospital stay, cosmetic result, wound length and time to return to work. Results: Surgical complications, postoperative pain scores, analgesic requirements and time to return to work were similar for both procedures. Statistically significant advantages of SILC were a shorter hospital stay, shorter total wound length and better cosmetic appearance. Duration of operation was significantly shorter for MLC. Conclusion: SILC is superior to MLC in terms of cosmetic outcome, but not in postoperative pain and requirement for analgesics. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]


    Capillary haemangioma of the eyelids and orbit: a clinical review of the safety and efficacy of intralesional steroid

    ACTA OPHTHALMOLOGICA, Issue 3 2003
    Michael O'Keefe
    Abstract. Purpose:, To describe the presenting features, investigations, treatment and outcome of a series of patients with capillary haemangioma of the eyelids and orbit. Methods:, A retrospective analysis of 21 patients, presenting between the years 1985 and 2000. Effectiveness of treatment was determined by final visual acuity and cosmetic result. Results:, Lesions were more common in females and the upper eyelid was a definite site of predilection. A total of 87.5% of lesions presented within 6 weeks of birth. Intralesional steroid injections were received by 79% of patients. Amblyopia was a definite complication. No local or systemic complications were associated with intralesional steroid injection. Surgery and laser treatment were reserved for persistent lesions. Conclusion:, Early recognition and prompt treatment with intralesional steroid prevents early occlusion amblyopia, but follow-up and management of refractive amblyopia with glasses and patching is necessary in the longer term. In this series, intralesional steroid proved to be a safe effective treatment. [source]


    Treatment options for giant congenital naevi

    CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 1 2000
    Lawrence
    Giant congenital naevi (GCN) are disfiguring, potentially malignant pigmented naevi present at birth. The naevus cells in GCN are found throughout the dermis and sometimes penetrate the subcutaneous septa. It is claimed that superficial, more heavily pigmented and biologically different naevus cells reside in the upper dermis. Partial removal of these superficial naevus cells by dermabrasion, laser therapy, curettage or shave excision is less traumatic than excision surgery and produces an acceptable cosmetic result. However, none of these techniques or excision of GCN to superficial fat completely removes the risk of malignant transformation. [source]


    Topical therapy with imiquimod for eyelid lesion

    CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 2 2006
    Hughie Hc Tsang MB BS
    Abstract Herein a case of clinically diagnosed lower eyelid lesion treated with topical imiquimod is reported. Macroscopic resolution of the lesion occurred 4 weeks after treatment with good cosmetic result. This is the first reported successful case of using this drug in treating eyelid lesion involving the lid margin. [source]


    Basal cell carcinoma mistaken for actinic keratosis

    CLINICAL AND EXPERIMENTAL OPTOMETRY, Issue 3 2006
    Robert J Jacobs PhD MSc(Optom) LOSc FAAO FVCO
    Increasing age and UV exposure are well-known associations with precancerous and cancerous skin lesions, including actinic (solar) keratosis, and squamous and basal cell carcinomata. This report describes a patient with a facial skin lesion close to an eye that was initially believed to be actinic (solar) keratosis but was subsequently diagnosed as a basal cell carcinoma (BCC). The diagnosis of BCC was helped pre-operatively by manipulation of the surrounding facial skin, which revealed the characteristic rolled edges and telangiectasis. Referral to his general medical practitioner (GP) resulted in surgical excision of the lesion. This procedure was performed inexpensively by the local GP as the lesion was not large and was in an accessible position. The lesion and the course of recovery over four weeks were documented photographically. The lesion was surgically excised and the diagnosis of basal cell carcinoma was confirmed by pathological examination. The wound healed well and the final cosmetic result was excellent. This patient illustrates the importance of careful observation and photo-documentation of suspicious skin lesions. A review of the treatment options for these lesions is included in this report. [source]


    Cloaca-like deformity with faecal incontinence after severe obstetric injury , technique and functional outcome of ano-vaginal and perineal reconstruction with X-flaps and sphincteroplasty

    COLORECTAL DISEASE, Issue 8 2008
    A. M. Kaiser
    Abstract Objective, Surgical technique and outcomes report. Summary background data, Three to eight per cent of vaginal deliveries are complicated by third- or fourth- degree perineal lacerations, resulting in a cloaca-like deformity in up to 0.3%. These three-dimensional defects result in often debilitating incontinence and symptoms similar to a rectovaginal fistula because of the lack of the distal rectovaginal septum. Method, Between 2001 and 2006, 12 women (median age 37, range 20,57) with faecal incontinence and a postobstetric-injury-associated cloaca-like deformity underwent an ano-vaginal and perineal reconstruction with X-flaps and sphincteroplasty without primary faecal diversion. Results, The patients presented 13.0 ± 2.9 years (range 0.5,29 years) after the obstetric injury. The median Cleveland Clinic Florida faecal incontinence score was 16 (range 12,19). In addition, one patient complained of vaginal discharge, another of dyspareunia. All patients had an open rectovaginal communication with a large anterior sphincter defects (mean 160.2 ± 22.8 degrees, range 113,180). Resting/squeeze pressures were 28.0 ± 4.4/63.2 ± 8.1 mmHg, respectively. Pudendal neuropathy was present in five patients. The median length of hospital stay after surgery was 5.3 ± 0.7 days. Three patients experienced a postoperative rectovaginal fistula, two of which closed spontaneously, whereas the third required faecal diversion and a bulbocavernosus flap. After surgical follow-up of 9.8.3 ± 2.8 months and long-term follow-up of 38.9.0 ± 6.9 months, all the patients were satisfied with regards to overall function, continence and cosmetic result. Conclusion, Cloaca-like deformity resulting from severe obstetric injury is often not given appropriate attention. Reconstruction of the original anatomy is complex but achieves good results and does not require a prophylactic faecal diversion. [source]


    Equal Cosmetic Outcomes with 5-0 Poliglecaprone-25 Versus 6-0 Polypropylene for Superficial Closures

    DERMATOLOGIC SURGERY, Issue 7 2010
    LAURA B. ROSENZWEIG MD
    BACKGROUND Cutaneous sutures should provide an aesthetically pleasing result. After placing subcutaneous sutures, enough absorbable suture often remains for the superficial closure. Mohs surgeons often use a nonabsorbable suture to close the superficial layer to obtain cosmetically elegant results, but using this additional suture is less cost effective than using the remaining absorbable suture. OBJECTIVES To compare the cosmetic results of simple running sutures using an absorbable suture material (5-0 poliglecaprone-25) with those of a nonabsorbable suture (6-0 polypropylene) in primary closures of suitable facial Mohs defects. MATERIALS AND METHODS Fifty-two patients with 57 facial Mohs surgery defects appropriate for multilayer primary repair had the defects prospectively randomized into a side-by-side comparison. After closure of the deep layers with 5-0 poliglecaprone-25 sutures, half of the wound was closed with a 5-0 poliglecaprone-25 simple running suture, and the other half of the wound was closed with a 6-0 polypropylene simple running suture. The investigators blindly determined the cosmetically superior side of the closure at 1 week and 4 months after suture removal. RESULTS Forty-four patients (48 total defects) completed the study. At the 4-month follow-up, 85% (41/48) did not show any difference between poliglecaprone-25 and polypropylene, 4% (2/48) had better outcomes with poliglecaprone-25, and 10% (5/48) had better outcomes with polypropylene. There was no statistically significant cosmetic difference between the two closure types. Wound complications such as infection, hematoma, and dehiscence did not occur in any of the patients. CONCLUSION In primary closures of facial defects, using 5-0 poliglecaprone-25 or 6-0 polypropylene for the superficial closure did not affect the cosmetic result. Therefore, 5-0 poliglecaprone-25 provides a comparable and cost-effective alternative to nonabsorbable sutures for epidermal approximation in layered closures. The authors have indicated no significant interest with commercial supporters. [source]


    Clinical Trial of Dual Treatment with an Ablative Fractional Laser and a Nonablative Laser for the Treatment of Acne Scars in Asian Patients

    DERMATOLOGIC SURGERY, Issue 7 2009
    SANGEUN KIM MD
    BACKGROUND Many methods have been proposed for the treatment of acne scars, with variable cosmetic results. Nonablative skin resurfacing is one method that has been proposed. Because of a need for more noticeable clinical improvements, the ablative fractional laser was recently introduced. OBJECTIVE To reduce complications and improve the results of ablative fractional laser resurfacing by combining this treatment of acne scars with nonablative lasers. METHODS A series of 20 patients (skin phototypes IV,V) with atrophic facial acne scars were randomly divided into two groups that received three successive monthly treatments with an ablative fractional laser using high (group A) and low (group B) energy on one facial half and an ablative fractional laser with low energy plus a nonablative resurfacing laser on the other facial half. Patients were evaluated using digital photography at each treatment visit and at 3 months postoperatively. Clinical assessment scores were determined at each treatment session and follow-up visit. RESULTS Although the use of the ablative fractional laser with high energy resulted in an improvement in patients' acne scars, the combination of ablative fractional laser resurfacing and nonablative laser resurfacing yielded the best results, as assessed in photographs as well as by the overall appearance of the acne scars. With the combination method, fewer complications were observed. [source]


    Trichloroacetic Acid Matricectomy in the Treatment of Ingrowing Toenails

    DERMATOLOGIC SURGERY, Issue 6 2009
    SU-HAN KIM MD
    BACKGROUND Ingrowing toenails can be treated with conservative therapy or surgery, but frequent relapse can be a problem in conservative therapy and surgical therapy without matricectomy. Thus, permanent nail ablation by partial matricectomy is now accepted as the treatment of choice. OBJECTIVE To evaluate the efficacy and safety of trichloroacetic acid (TCA) matricectomy in the treatment of ingrowing nail. MATERIALS AND METHODS Forty ingrowing toenail edges in 25 patients were enrolled. TCA matricectomy with 100% trichloroacetic acid after partial nail avulsion was performed. For a few weeks after surgery, postoperative complications such as pain, discharge, and infection were assessed. After a mean follow-up period of 22.9 months, recurrence rate and cosmetic outcomes were investigated to evaluate the effects of the surgery. RESULTS The wounds almost always healed within 2 weeks without prolonged exudative discharge. Pain was mild and transient. A case of secondary infection occurred. Recurrence was found in only two nails of one patient, and the success rate was 95%, with good cosmetic results. CONCLUSION TCA matricectomy showed a low recurrence rate with minimal side effects and was easy to perform in outpatient clinic. Therefore, it may be a good alternative treatment of ingrowing toenails. [source]


    Photodynamic Therapy for the Treatment of Cutaneous Neoplasia, Inflammatory Disorders, and Photoaging

    DERMATOLOGIC SURGERY, Issue 5 2009
    EMILY TIERNEY MD
    BACKGROUND Photodynamic therapy (PDT) has demonstrated high efficacy, minimal side effects, and improved cosmetic outcome when used for the treatment of actinic keratoses (AK), basal cell carcinoma (BCC), squamous cell carcinoma, and photoaging. METHODS To review the literature on the use of PDT in dermatologic surgery using MEDLINE. RESULTS Published clinical studies using PDT in the treatment of AKs yield overall efficacy rates ranging from 50% to 71% with one treatment to as high as 88% to 90% with two or more treatments. For superficial BCC, initial clearance rates were 76% to 97%, and for Bowen's disease, initial clearance rates ranged from 72% to 94% overall. The use of PDT for photorejuvenation is a relatively new application of this technology, which has shown promise in improving the appearance of fine lines, pigmentary variation, and telangiectasias. CONCLUSIONS The advantages of photodynamic therapy include the capacity for noninvasive targeted therapy through topical application of aminolevulinic acid and methyl aminolevulinic acid, with outstanding cosmetic results. Although the theory behind the use of chemical photosensitizers and ultraviolet light to treat a wide variety of skin disorders is straightforward, the practical application of this technology is evolving. Additional research into the precise mechanisms of action for specific photosensitizers and optimal light sources will be highly beneficial to the advancement of this technology. [source]