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Verma V, Gupta S. Commentary on Surgical Excision With Healing by Secondary Intention: An Effective Treatment Option for Refractory Acne Keloidalis Nuchae. Dermatol Surg 2024:00042728-990000000-00663. [PMID: 38450659 DOI: 10.1097/dss.0000000000004108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Affiliation(s)
- Vaishnavi Verma
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, New Delhi, India
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Balakirski G, Becker SL, Hartmann D, Kofler L, Kunte C, Müller CSL, Volz T, Kendziora B, Schlager JG, Löser CR. Perioperative Antibiotikaprophylaxe in der Dermatochirurgie - Positionspapier der Arbeitsgruppe Antibiotic Stewardship der Deutschen Gesellschaft für Dermatochirurgie (DGDC), Teil 2: Spezielle Indikationen und Situationen. J Dtsch Dermatol Ges 2023; 21:1109-1119. [PMID: 37845076 DOI: 10.1111/ddg.15153_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/18/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungNeben der Vermeidung postoperativer Wundinfektionen nach dermatochirurgischen Eingriffen hat die perioperative Antibiotikaprophylaxe (PAP) das Ziel, das Auftreten weiterer postoperativer Infektionskomplikationen, insbesondere der bakteriellen Endokarditis oder hämatogener Gelenkprotheseninfektionen, zu verhindern. In der vorliegenden Arbeit werden spezielle Situationen dargestellt, in denen eine PAP notwendig werden kann. So benötigen Patienten nach Herzklappenersatz jeglicher Art, einschließlich Transkatheter‐Klappenersatz oder bei Verwendung von Prothesenmaterial zur Herzklappenkorrektur, oder Patienten nach einer durchgemachten bakteriellen Endokarditis bei zweizeitigen dermatochirurgischen Eingriffen, Eingriffen an der Schleimhaut oder ulzerierten Tumoren eine PAP.Auch die Anwendung einer PAP in speziellen Situationen wie bei sekundärer Wundheilung, septischen dermatochirurgischen Eingriffen oder Ulcus cruris‐Chirurgie werden in dieser Arbeit anhand der aktuellen wissenschaftlichen Literatur ausführlich dargestellt und diskutiert. Die vorliegende Arbeit ist der 2. Teil des Positionspapiers der Arbeitsgruppe Antibiotic Stewardship der Deutschen Gesellschaft für Dermatochirurgie und formuliert evidenzbasierte Empfehlungen für die Verabreichung einer PAP bei dermatochirurgischen Eingriffen bei speziellen Indikationen und Situationen. Dies ist von besonderer Wichtigkeit, da bei dermatochirurgischen Eingriffen, wie im ersten Teil dargelegt, im Regelfall auf eine PAP verzichtet werden kann und sollte.
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Affiliation(s)
- Galina Balakirski
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal
| | - Sören L Becker
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Daniela Hartmann
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München
| | - Lukas Kofler
- Universitäts-Hautklinik, Universitätsklinikum Tübingen, Tübingen
| | - Christian Kunte
- Dermatochirurgie und Dermatologie, Artemed Fachklinik München GmbH & Co. KG, München
| | | | - Thomas Volz
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, München
| | - Benjamin Kendziora
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München
| | - Justin Gabriel Schlager
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München
| | - Christoph R Löser
- Hautklinik, Hauttumorzentrum, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Ludwigshafen
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Balakirski G, Becker SL, Hartmann D, Kofler L, Kunte C, Müller CSL, Volz T, Kendziora B, Schlager JG, Löser CR. Perioperative antibiotic prophylaxis in skin surgery - Position paper of the Antibiotic Stewardship working group of the German Society for Dermatologic Surgery (DGDC), Part 2: Special indications and situations. J Dtsch Dermatol Ges 2023; 21:1109-1117. [PMID: 37501398 DOI: 10.1111/ddg.15153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/18/2023] [Indexed: 07/29/2023]
Abstract
In addition to prevention of surgical site infections after skin surgery, perioperative antibiotic prophylaxis (PAP) aims to prevent the occurrence of other postoperative infectious complications, especially bacterial endocarditis and hematogenous joint prosthesis infections. This article discusses specific indications for the use of PAP. For example, patients who have undergone any type of heart valve replacement, including transcatheter valve replacement or use of prosthetic material to correct the heart valve, or patients who have experienced bacterial endocarditis, require PAP during skin surgery on mucosal membranes or ulcerated tumors. The use of PAP in special situations such as secondary wound healing, septic dermatosurgery or ulcer surgery is also presented and discussed in detail in this paper based on the current scientific literature. This paper represents the second part of the position paper of the Antibiotic Stewardship Working Group of the German Society for Dermatologic Surgery (DGDC) and summarizes evidence-based recommendations for the administration of PAP during skin surgery for special indications and situations. This is particularly important because, as detailed in Part 1 of this position paper, PAP can and usually should be avoided in skin surgery.
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Affiliation(s)
- Galina Balakirski
- Center for Dermatology, Allergology and Dermatosurgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Lukas Kofler
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Christian Kunte
- Department of Dermatologic Surgery and Dermatology, Artemed Clinic Munich, Munich, Germany
| | - Cornelia S L Müller
- Medical Supply Center for Histology, Cytology, and Molecular Diagnostics Trier, Trier, Germany
| | - Thomas Volz
- Department of Dermatology and Allergology, University Medical Center, Technical University of Munich, Munich, Germany
| | - Benjamin Kendziora
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Justin Gabriel Schlager
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Christoph R Löser
- Department of Dermatology, Ludwigshafen City Hospital, Ludwigshafen, Germany
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Wong N, Zloty D. Secondary Intention Healing Over Exposed Bone on the Scalp, Forehead, and Temple Following Mohs Micrographic Surgery. J Cutan Med Surg 2022; 26:274-279. [PMID: 35134314 DOI: 10.1177/12034754221077903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Removal of skin cancers on the scalp, forehead, and temple can result in surgical defects with exposed bone. In such cases, reconstruction becomes challenging due to limited vascularity for flap or graft repair. OBJECTIVE Demonstrate the usefulness of secondary intention healing of scalp, forehead, and temple defects over exposed bone. METHODS/MATERIALS A retrospective case series of 41 patients who had Mohs Micrographic Surgery with post-surgical scalp, forehead, or temple defects involving exposed bone. These patients then underwent secondary intention healing. RESULTS 90% of patients successfully healed. Average time to complete granulation was 92 days, and average time to full re-epithelialization was 186 days. Visual analog scale assessment of final scar quality resulted in 57% being good, 35% being fair, and 8% being poor. No patient had infection or other serious complication. Mean follow-up duration was 272 days. CONCLUSION This case series shows the viability of secondary intention healing of scalp wounds over exposed bone. Study power was not adequate to predict time to complete healing based on defect size, or allow association of patient factors with the risk of nonhealing. Managing patient expectations, and emphasizing the importance of early occlusive wound care is paramount for healing success.
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Affiliation(s)
- Noelle Wong
- 8166119508 Department of Dermatology and Skin Science, The University of British Columbia, Vancouver, Canada
| | - David Zloty
- 8166119508 Department of Dermatology and Skin Science, The University of British Columbia, Vancouver, Canada
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Repair of an Extensive Central Chest Defect. Dermatol Surg 2021; 47:1103-1105. [PMID: 32049704 DOI: 10.1097/dss.0000000000002345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yadav SP, Gharwade CR, Khatri GN. Punch Incision with Secondary Healing (PISH) Technique for Benign Facial Lesions: An Institutional Experience in 307 Patients. Indian J Plast Surg 2021; 54:138-143. [PMID: 34239234 PMCID: PMC8257327 DOI: 10.1055/s-0041-1731257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background
Multiple or solitary facial lesions pose a unique challenge to the attending surgeon in terms of delivering the best cosmetic outcome. There are various methods in dealing with them and the preference of using them is based on the surgeon’s experience, patient expectations, and availability of instruments. One such tool, skin-punch, primarily designed for a biopsy can play a very important therapeutic role in this era of keyhole surgery. In this paper, we assess the technique of punch incision with its combination of secondary healing for various facial lesion.
Methods
This observational study, a total of 307 patients with solitary or multiple benign facial lesions were treated with punch incision technique using 2 to 6 mm sterile, disposable skin biopsy punches. Subsequently, the wounds were managed with healing with secondary intention.
Results
In our series all superficial wounds epithelized by 7 to 14 days while the deeper lesions epithelized by 14 to 28 days. We had three recurrences which were managed by fusiform excision and one patient had surgical site infection which was managed conservatively. On application of our self-devised facial scar scoring system (SCAR or Scar Cosmesis Assessment and Rating)
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on all the scars, the mean score was 6 at 1 year followup.
Conclusion
Punch incision with healing by secondary intention is a relatively easy, effective, single-stage office procedure. This method can be considered as an alternative method for the removal of various skin lesions, especially on face, thus providing a simple solution to complex problems.
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Affiliation(s)
- Sudeep Pradeep Yadav
- Department of Plastic & Reconstructive Surgery, Balaram Building, Grant's Government Medical College & Sir J.J. Group of Hospitals, Sir J.J. Marg, Mumbai, Maharashtra, India
| | - Chandrakant Rambhau Gharwade
- Department of Plastic & Reconstructive Surgery, Balaram Building, Grant's Government Medical College & Sir J.J. Group of Hospitals, Sir J.J. Marg, Mumbai, Maharashtra, India
| | - Gayatri Nagindas Khatri
- Department of Dermatology and Cosmetology, Khatri Clinic, Pune Camp, Pune, Maharashtra, India
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Cammarata E, Zavattaro E, Astolfi S, Airoldi C, Giorgione R, Boggio P, Savoia P. Purse-string suture versus full-thickness skin graft: An efficacy and safety comparison study. Dermatol Ther 2021; 34:e14909. [PMID: 33619872 DOI: 10.1111/dth.14909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
Purse-string suture (PSS) and full-thickness skin graft (FTSG) are two different approaches to the closure of circular skin defects. In this study, we compare the feasibility and the aesthetic outcome of these two techniques in high operatory risk non-melanoma skin cancer (NMSC) patients. We performed a retrospective study on 65 patients, treated with PSS or FTSG, and evaluated after a minimum follow-up of 6 months. The post-surgery assessment was based on the Vancouver scar scale (VSS) and differences in terms of defect areas, operative and healing times were performed both with parametric and nonparametric tests. Operative times in PSS were significantly lower than those needed for FTSG, without perioperative adverse events; PSS required a waiting time before removing the suture greater than FTSG. After surgery, PSS resulted in a median defect area reduction of 73%. No significant differences were found in the median value for VSS in the two groups. Based on our clinical experience, the PSS advantages in terms of feasibility, rapidity of execution, and mean defect area reduction were confirmed. So, this technique seems to be appropriate for fragile patients affected by NMSC, that cannot hold long surgical sessions.
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Affiliation(s)
- Edoardo Cammarata
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - Elisa Zavattaro
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | - Chiara Airoldi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | - Paolo Boggio
- Dermatology Unit, AOU Maggiore della Carità, Novara, Italy
| | - Paola Savoia
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
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Park B, Seong G, Yeom K, Yun D, Choi M, Kim M. A retrospective study to evaluate the efficacy and safety of staged purse-string sutures for the reconstruction of surgical defects on skin using computer image analysis program. Indian J Dermatol 2021; 66:645-648. [PMID: 35283493 PMCID: PMC8906307 DOI: 10.4103/ijd.ijd_402_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Staged purse-string suturing has been recently introduced for the reconstruction of round or oval defects following tumor excision. Objective: The aim of this study was to evaluate the clinical advantage of staged purse-string suturing for the reconstruction of relatively large skin defects. Materials and Methods: Twenty-one patients who received staged purse-string sutures were included in the study. To evaluate the defects and scar sizes objectively, computer-based image analysis was used. A modified observer scar assessment scale (OSAS) was applied for evaluating the clinical efficacy. Results: The mean primary postsurgical defect size in the total 21 cases was 1446.2 ± 1187.2 mm2, and the mean final scar size was about 268.1 ± 252.3 mm2. The defect area decreased gradually as staged purse-string suturing was performed. The mean total modified OSAS was 7.96 ± 1.69. Conclusion: Staged purse-string sutures might be an alternative reconstructive method for relatively large round or oval skin defects.
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Three Neighboring Shoulder Defects. Dermatol Surg 2020; 46:267-269. [PMID: 32045388 DOI: 10.1097/dss.0000000000001729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jin W, Jin S, Li Z, Jin Z, Jin C. Second intention healing of nasal ala and dorsum defects in Asians. J DERMATOL TREAT 2019; 32:465-468. [PMID: 31530052 DOI: 10.1080/09546634.2019.1666204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Reconstruction of defects of nasal ala and dorsum after surgical excision presents a substantial challenge to dermatologic surgeons. Second intention healing is a simple and extremely useful method to optimize cosmesis after skin cancer removal. OBJECTIVES This study reported the cosmetic outcomes after second intention healing of nasal ala and dorsum defects in Asians, and estimated the time to epithelialization and complete healing. MATERIALS AND METHODS Fifteen defects (<1 cm in diameter) of the nasal ala and dorsum in 10 patients were allowed to heal by secondary intention. Cosmetic results were evaluated and the time to epithelialization and complete healing were recorded. RESULTS Cosmetic outcomes were good to excellent in 80% of the defects; defects of the dorsum showed poorer cosmetic results than defects of the ala. The wounds needed 5-17 days (mean 11.3; SD ± 4.18) to complete epithelialization and 10-24 days (mean 17.7; SD ± 4.85) to heal completely. CONCLUSIONS Second intention healing of small nasal ala and dorsum defects (<1 cm in diameter) in Asians produces satisfactory cosmetic results with a low complication rate.
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Affiliation(s)
- Wenyan Jin
- Department of Dermatology, Yanbian University Hospital, Yanji, Jilin, China
| | - Shan Jin
- Department of Dermatology, Yanbian University Hospital, Yanji, Jilin, China
| | - Zhouna Li
- Department of Dermatology, Yanbian University Hospital, Yanji, Jilin, China
| | - Zhehu Jin
- Department of Dermatology, Yanbian University Hospital, Yanji, Jilin, China
| | - Chenglong Jin
- Department of Dermatology, Yanbian University Hospital, Yanji, Jilin, China
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Strategies for Reducing Final Surgical Defect Sizes in the Treatment of Lentigo Maligna. Dermatol Surg 2019; 46:537-545. [PMID: 31464705 DOI: 10.1097/dss.0000000000002099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lentigo maligna (LM) is associated with disproportionately high surgical morbidity. OBJECTIVE The authors report on 2 strategies to reduce the surgical morbidity associated with LM. METHODS Forty LM lesions were removed with excisional biopsies without margins and closed with purse-string sutures. Invasive cases underwent staged excisions with 10-mm margins. Cases without invasion were treated with neoadjuvant topical imiquimod 5% cream (5 d/wk × 8 weeks) followed by conservative staged excisions with 2-mm margins using radial sections stained with hematoxylin and eosin and immunostaining with Mart-1, with or without SOX10. RESULTS Invasion was detected in 12/40 (30%) of the excisional biopsy specimens (average depth 0.45 mm). No invasion was detected in 28/40 (70%). All 24 patients who completed neoadjuvant topical imiquimod 5% cream before staged excisions had negative first-stage margins at 2 mm. Compared with average published margins for LM, this represents a 71.4% reduction in the required margin and an average reduction in the final surgical defect by 74%. CONCLUSION LM treatment by excisional biopsies with a purse-string closure enables accurate tumor staging and contracts the tumor footprint to its minimal size. Subsequent neoadjuvant imiquimod followed by a conservative staged excision with 2-mm margins allows for removal of LM with decreased surgical morbidity.
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Paine AR, Billingsley EM, Lam C. Purse-string suture for ear lobule reconstruction: A novel solution. J Am Acad Dermatol 2019; 83:e279-e280. [PMID: 31228525 DOI: 10.1016/j.jaad.2019.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/14/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Allison Rogers Paine
- Department of Dermatology, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Elizabeth M Billingsley
- Department of Dermatology, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Charlene Lam
- Department of Dermatology, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Biondo-Simões MDLP, Henning Júnior L, Boen BRDO, Prado JLD, Costa LRD, Robes RR, Ioshii SO. Análise comparativa dos efeitos do mel, do óleo-serina de copaíba e de um produto comercial (fibrinolisina, desoxirribonuclease e cloranfenicol) na cicatrização por segunda intenção, em ratos. Rev Col Bras Cir 2019; 46:e20192245. [DOI: 10.1590/0100-6991e-20192245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/10/2019] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: comparar a cicatrização, por segunda intenção, sob os efeitos da aplicação tópica de mel, óleo-resina de copaíba e um produto comercial (fibrinolisina, desoxirribonuclease e cloranfenicol) a um grupo controle, em ratos. Métodos: ressecção de pele, com 1cm de diâmetro, foi realizada no dorso de 40 ratos alocados em quatro grupos de dez animais. Todas as feridas foram limpas, diariamente, com 2ml de solução de NaCl 0,9%. O primeiro grupo (controle - GC) ficou restrito a tal procedimento. Nas feridas do segundo (GM), terceiro (GO) e quarto grupos (GF), após limpeza, aplicou-se, respectivamente, 1ml de mel, 1ml de óleo-resina de copaíba e 1ml de creme contendo fibrinolisina, desoxirribonuclease e cloranfenicol. Ocluíram-se as feridas com gaze estéril. Imediatamente após a incisão e nos dias três, sete e 14 do experimento, as feridas foram copiadas e, usando planimetria, analisou-se a contração. Após a eutanásia, a histologia foi utilizada para avaliação da reação inflamatória e do colágeno nas cicatrizes. Resultados: a redução da área da ferida do GM (p=0,003), GO (p=0,011) e GF (p=0,002) foram superiores ao do GC. A quantidade de colágeno tipo I presente no GM e no GO foi superior aos grupos GC e GF (p<0,05). Houve predominância do estágio inflamatório crônico no GM (p=0,004), GO (p<0,001) e GF (p=0,003) quando comparados ao GC. Conclusão: o uso tópico do mel e do óleo-resina de copaíba aumenta a contração da ferida, a presença de colágeno tipo I e acelera a cicatrização.
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Osorio M, Moubayed SP, Weiss E, Urken ML. Management of a nonhealing forehead wound with a novel frontalis-pericranial flap and a full-thickness skin graft. Laryngoscope 2016; 126:2456-2458. [DOI: 10.1002/lary.26015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/24/2016] [Accepted: 03/10/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Marcela Osorio
- Thyroid, Head, and Neck Cancer (THANC) Foundation; New York New York
| | - Sami P. Moubayed
- Thyroid, Head, and Neck Cancer (THANC) Foundation; New York New York
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Beth Israel; New York New York
| | - Elliot Weiss
- Department of Dermatology; Weill Cornell Medical College; New York New York U.S.A
| | - Mark L. Urken
- Thyroid, Head, and Neck Cancer (THANC) Foundation; New York New York
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Beth Israel; New York New York
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