Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
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Comparative Study
Saphenofemoral incompetence treated by ultrasound-guided sclerotherapy.
Published long-term recurrence rates are higher after sclerotherapy than after surgery for the treatment of varicose veins involving greater saphenous tributaries associated with saphenofemoral incompetence (SFI). Duplex ultrasound has recently become the gold standard for the diagnosis of venous disorders, and over the past 5 years, has been utilized during sclerotherapy to guide injections more precisely. ⋯ Duplex ultrasound enhances the precision and therefore, both the efficacy and safety of saphenous vein sclerotherapy when performed by experienced practitioners. While awaiting long-term follow-up to document the progressive recurrence rate over time, our results at 2 years are superior to those after conventional sclerotherapy, and compare favorably with those after surgical interruption.
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Review Case Reports
Ambulatory phlebectomy. A rare complication of local anesthetic: case report and literature review.
Full-thickness skin necrosis can occur after infiltration of 1.0% lidocaine with 1/100,000 epinephrine for ambulatory phlebectomy. ⋯ Permanent scar formation after ambulatory phlebectomy was found in a patient with a previous probable exaggerated local response to epinephrine. Uneventful phlebectomy resulted in the same patient when epinephrine was deleted from the local anesthetic, suggesting a local inability to eliminate epinephrine or an exaggerated local alpha-one response.
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The 3S technique enables treatment of large incontinent greater saphenous veins in patients who, for medical or social reasons, refuse traditional surgical methods. It associates phlebectomy with section-ligation and injection of a sclerosing solution in the proximal and distal segments. The 3S technique is merely one stage in the treatment of the saphenous vein, aimed at suppressing reflux, and associated with sclerosis of the junction. It must always be combined with later sclerotherapy sessions. ⋯ Superficial venous insufficiency is a chronic disease with evolution or recurrences. To appreciate the efficiency of 3S technique, it will be better to have 5 years worth of follow-up. This is a preliminary study with a short follow-up.
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Case Reports Comparative Study
Silicone gel sheeting for the prevention and management of evolving hypertrophic and keloid scars.
Hypertrophic scars and keloids remain a problem for surgeons. Topical and intralesional corticosteroids, positive pressure dressings, cryotherapy, and laser therapy are helpful but not uniformly successful. ⋯ Daily treatments with silicone gel sheeting should begin as soon as an itchy red streak develops in a maturing wound. The dressing is effective in reducing the bulk of these lesions.