Alternative techniques for reduction of scar length during staged excision

Assessment of mathematical model for elliptical excision: solving the doubt about vertex angle and predicting postoperative wound length

BACKGROUND

Elliptical excision is the most commonly used method for small benign tumour excision and primary closure. However, elliptical excision remains the topic of debate. The aim of this study was to explore the relationship among postoperative incision, vertex angle, and the length and width of fusiform excision through a mathematical model.

METHODS

We collected data from fusiform circle excisions performed at the author's hospital (101 cases). The measured values were applied to the mathematical model formula for statistical analysis.

RESULTS

The functional relationships among the length, width, arc, and angle of the fusiform circle were obtained. The mean apical tangent angle was 100.731°±15.782°, and the mean apical inner angle was 50.366°±7.891°. There was no significant difference between the preoperatively designed arc length preoperative and the postoperative incision length (P < 0.001). The apical vertex push-out distance equals half of the value of the fusiform length subtracted from arc.

CONCLUSIONS

The mathematical model can be used to design the incision for ellipse fusiform excision to predict the final wound length.

Serial excision surgery for giant dorsal congenital melanocytic nevus: Case report

INTRODUCTION AND IMPORTANCE

Giant congenital melanocytic nevus increases the risk of melanoma and seriously affects the aesthetics and psychology of patients, influencing the personality development of children.

CASE PRESENTATION

A 7-year-old female child presented with a giant congenital melanocytic nevus on the back, which extended from the right anterior abdominal wall to the left flank Taking advantage of the elasticity of children's skin, we performed serial excision and obtained favourable results. The procedure included seven surgeries, and the average interval between the surgeries was 7 months. The nevus was partially resected from the periphery to the centre, and the direction of excision of the nevus depended on the mobilisation of the surrounding normal skin, including from the shoulder downward, lateral to medial, and from the bottom upward. After the seventh surgery at 11 years of age, the nevus was completely removed, and there were no complications.

CLINICAL DISCUSSION

Serial excision is a simple and less invasive surgical technique that can achieve both complete excision and a satisfactory aesthetic result for giant congenital melanocytic nevus. The giant nevus of the back can be removed completely after several procedures due to the very good elasticity of the skin and the great ability of natural expansion of healthy skin under a considerable stretching force in children.

CONCLUSION

Serial excision is an effective method for treating dorsal giant congenital melanocytic nevus in children because of excellent natural skin elasticity.

Staged Excision Technique to Reduce Scar Length

Patients and surgeons are often disappointed with the scar length after conventional staged excision of large disfiguring skin lesions. We have developed an alternative approach to facilitate scar length reduction. We aimed to report the efficacy of our staged excision method, which includes a hexagonal-pattern excision, wide undermining, and purse-string suture. Sixty-five patients, each with one lesion, were included in the current study. The lesion length and width were recorded, and the scar area was calculated at each stage. The final scar length after performing the altered staged excision method was compared with that obtained after the conventional staged excision method, which was calculated using a theoretical scar model. Patient satisfaction was also evaluated. The mean longest axis length was 9.41 ± 3.83 cm preoperatively, 9.50 ± 3.92 cm after the first stage postoperatively, and 10.19 ± 3.98 cm after the final stage. The mean lesion width was 6.50 ± 3.48 cm preoperatively, 3.60 ± 1.77 cm after the first stage postoperatively, and 0.42 ± 0.31 cm after the final stage. The final scar length obtained using the altered procedure was much shorter than what would be obtained using conventional staged excision. The patient satisfaction score was 8.8 ± 1.1 out of a possible 10.0 rating. Staged excision with a hexagonal-pattern excision, wide undermining, and purse-string closure may improve aesthetic results.

Staged excision of a cheek congenital melanocytic nevus: a case report and literature review

Congenital melanocytic nevi (CMNs) have a risk of malignant degeneration and are aesthetically unpleasing. Serial excision, skin grafting, and tissue expansion are applied to remove difficult CMNs. However, complications such as expander infection, malposition, skin colour mismatch, and scar contractures are known to occur. Staged excision is typically used to remove disfiguring or precancerous lesions to reduce the loss of function or minimize patient debilitation. This study aimed to describe a successful staged excision for removing a CMN on the face of a young girl without noticeable complications and then discuss the different treatments for CMNs to improve the understanding of and skillfully apply staged excision for these lesions.

Dosimetric comparison of volumetric modulated arc therapy (VMAT) and high-dose-rate brachytherapy (HDR-BT) for superficial skin irradiation with significant curvature in one or more planes

PURPOSE

This study compares the plan quality of high-dose-rate brachytherapy (HDR-BT) and volumetric modulated arc therapy (VMAT) for superficial irradiation of large areas of skin with significant curvature in one or more planes.

METHODS

A total of 14 patients from two centres previously treated with either HDR-BT or VMAT were retrospectively replanned using the alternative technique. Sites included scalp and lower limbs. Identical computed tomography (CT) scans, clinical target volume (CTV) and organs at risk (OARs) and prescription were used for both techniques. Conformity, skin surface dose and OAR doses were compared.

RESULTS

Conformity index was consistently better with VMAT than HDR-BT (p < 0.01). Maximum skin surface dose (D0.1cc) had a higher mean of 49.6 Gy with HDR-BT compared to 31.4 Gy for VMAT (p < 0.01). Significantly smaller volumes of healthy tissue were irradiated with VMAT than with HDR-BT. This can be seen in brain volumes receiving 10, 20 and 30 Gy EQD2 and in extremities receiving 5 and 10 Gy. When close to the volume, the lens received significantly lower doses with VMAT (p < 0.01).

CONCLUSION

In this small sample, VMAT gives equal coverage with lower OAR and skin surface doses than HDR-BT for both scalp and extremities. VMAT is a useful technique for treating large, superficial volumes with significant curvature in one or more planes.

Patient Preferences Comparing Linear Versus Purse String Closures in Dermatologic Surgery Utilizing a Novel Simulator-Based Educational Tool

BACKGROUND

Patients often query in regard to cosmetic outcomes after cutaneous surgery. This study provides information on this topic by surveying preference on 2 skin closure methods, purse and linear. The authors used a novel method to poll opinions by incorporating simulated skin within the context of the survey.

OBJECTIVE

To determine patient's preference for linear or purse string closure. Additional outcomes were to survey patient's opinions regarding which scar characteristics have the highest cosmetic impact, the cosmetic importance of a scar, and the utility of simulators, and patient photographs as methods of understanding closure techniques.

MATERIALS AND METHODS

Participants were prospectively recruited to complete a survey. Data outcomes were analyzed using descriptive statistics and the chi-square test of association.

RESULTS

About half of the participants (54.7%) preferred linear closure. Preference was independent of gender (p = .90) or having a prior linear or purse string closure (p = .17). Patient photographs were the most influential for determining preference according to 86.2% of participants; however, 88% of the participants found simulator devices useful for educational purposes.

CONCLUSION

The methods in this survey may represent a venue for educating patients and incorporating their preferences into the choices they will make regarding dermatologic procedures, which they will undergo.

Palmieri's double suture skin repair: a new double suture approach to cases of skin cancer and ulcerative lesions

We describe two case reports to assess the efficacy of a new method suitable to close small-sized pressure ulcers and cancer-related skin lesions.

The biomechanical properties of the skin

BACKGROUND

The skin possesses unique biochemical properties that allow it to protect and conform to the body that it covers. Elements constituting the dermis-collagen and elastin-primarily afford these properties.

OBJECTIVES

To define these properties and explore their relevance with regard to aging skin and dermatologic surgery.

MATERIALS AND METHODS

In the first part of this review, the determinants of mechanical properties of the skin will be outlined, through an extensive review of the literature. General physical properties that explain the behavior of skin will be defined, and diseases that manifest the extremes of those properties will be discussed. In the second half of this discussion, the surgical implications of skin biomechanics will be reviewed.

RESULTS

Emphasis will be placed on understanding how dermatologic surgeons may optimally use skin properties to produce the best cosmetic and functional outcomes possible.

CONCLUSION

Understanding of the biomechanical properties of skin is paramount to obtain the best cosmetic outcomes in dermatologic surgery.