Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
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Tumescent anesthesia was originally described by Klein and Lillis for liposuction surgery. Its extension to many other interventions in dermatologic surgery (cosmetic and noncosmetic) has provided a significant contribution in the performance of safe, ambulatory, and simplified procedures. ⋯ Tumescent anesthesia is one the most substantial progressions in the field of cosmetic and reconstructive surgery, with advantages that by far outnumber the few disadvantages.
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The term Marjolin ulcer is now synonymous with malignant transformation of chronic ulcers, sinus tracts, and burn scars. ⋯ Because of the focal nature of malignant change in burn scars, incisional or excisional biopsy should be performed.
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The transplantation of large numbers of three- to five-hair minigrafts has superseded the use of traditional punch grafts in hair restoration surgery. The minigrafts are usually designed and cut in a square or rectangular shape for implantation into the recipient slits. Transplanting a large number of these grafts into the recipient slits can lead to a high frequency of complications, especially in cases in which there is a need for dense packing of grafts. The complications include excess graft compression resulting in extrusion or retraction into the slit. This in turn can lead to piggybacking or insertion of two grafts per slit with the resultant effect of cyst formation, cobblestoning, and hypertrophic scar formation. ⋯ The rhomboid minigrafting technique (1.5 x 1.5 mm in size) seems to accommodate the grafts better into the recipient slits than the standard shape rectangular minigrafts. It thereby better facilitates the insertion of the grafts in the slits and reduces the frequency of graft extrusion as well as graft compression.
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Ambulatory phlebectomy is an elegant outpatient procedure for the removal of varicose veins. One of the keys to its success is the ability to perform the procedure under local anesthesia. A new form of anesthesia, tumescent anesthesia, has been developed for liposuction surgery and is now being expanded for use in other surgical disciplines. ⋯ Tumescent anesthesia provides a very safe, comfortable method of anesthetizing patients for ambulatory phlebectomy. Epinephrine, in appropriate concentrations, should be a part of all tumescent anesthetic solutions used for phlebectomy as it may decrease the incidence of hematoma.