Annals of plastic surgery
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Lentigo maligna (LM) presents a challenge for complete surgical excision. Imiquimod is a topical immune-response modifier that acts on the immune system. We report our experience using imiquimod 5% cream as a surgical alternative for treatment of LM. ⋯ Side effects included erythema (86%) and crusting (71%), resulting in dose alteration in 71% of patients. Topical imiquimod therapy demonstrates a high response rate for treatment of LM, with tolerable side effects. Further investigation into its efficacy in the treatment of LM in controlled clinical trials is warranted.
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Annals of plastic surgery · Oct 2008
Spectrophotometric intracutaneous analysis: a novel imaging technique in the assessment of acute burn depth.
The noncontact spectrophotometric intracutaneous analysis scope (SIAscope) is a novel portable imaging device that rapidly produces images of the blood and melanin content of large areas of skin. The estimation of burn depth is often difficult in the clinical setting, and this pilot study was conducted to assess the potential for the SIAscope in aiding burn assessment. ⋯ Results showed that superficial partial thickness burns had increased hemoglobin and loss of melanin on SIAgraphs, whereas deep partial thickness burns had more pronounced hemoglobin concentrations and apparent melanin increases, helping to differentiate these 2 burn types. The SIAscope, a relatively inexpensive, portable device, has the potential to be a highly useful clinical adjunct in the bedside estimation of acute burn depth.
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Annals of plastic surgery · Oct 2008
Breast-feeding, self-exam, and exercise practices before and after reduction mammoplasty.
The current indications for reduction mammoplasty include the relief of painful physical symptoms of macromastia. Numerous studies have demonstrated not only improvement in physical symptoms following reduction mammoplasty, but postoperative psychological benefits as well, including increased ability to participate in physical activity as a result of pain relief and decreased breast mass. Reduction mammoplasty may have additional effects on the patient's ability to breast-feed and perform breast self-exam. ⋯ Eighty-nine percent of participants had no children following surgery, therefore effects on breast-feeding practices following reduction mammoplasty were not statistically significant. However, we suggest that when patients are seen in consultation or in the perioperative period, there is an opportunity to teach patients about the benefits of breast-feeding, and to assure patients that a pedicle flap reduction will likely allow breastfeeding. This is also a chance for physicians to teach patients how to perform breast self-examination and explain the importance of early breast mass detection.
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Angiosarcomas (AS) of the scalp are rare tumors with an extremely poor prognosis mostly affecting elderly patients. Given the special anatomic nature of the blood supply to the scalp, it must be presumed that the tumor has already spread at the time of the initial presentation. We report a simple and fast surgical procedure, which places only a minimum burden on the patient. ⋯ The postoperative period free of recurrences was 2.7 months on average. The average survival period after resection was 17.5 months. In view of the difficult diagnosis, an often delayed therapy and the rapid formation of metastases, a time-saving procedure with a low rate of complications should be given preference over other reconstructive methods.
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Annals of plastic surgery · Sep 2008
Case ReportsChronic postburn palmar contractures reconstruction using the medial pedis perforator flap.
Chronic flexion contractures of the palm of the hand impair hand function considerably and cause a poor esthetic appearance. Various reconstructive methods have been used for the treatment. However, satisfactory esthetic and functional results are difficult to achieve due to the unique anatomic characteristics of the palmar region, such as thick, cornified, stratified squamous epithelium. ⋯ In one case, the flap required debulking. Postoperative follow-up revealed no marked donor site morbidity. We determined that the medialis pedis flap was a remarkable alternative for palmar reconstruction of the hand and digits due to burn because of its glabrous skin, which was very similar to palmar skin, and low donor site morbidity.