1
|
Goebel GJ, Loewenstein SN, Adkinson JM. Parent Perspectives for Type B Ulnar Polydactyly Management. Hand (N Y) 2023; 18:1357-1361. [PMID: 35658690 PMCID: PMC10617471 DOI: 10.1177/15589447221096707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Type B ulnar polydactyly is one of the most commonly encountered congenital hand differences and can be treated with ligation or excision. The purpose of this study was to determine what factors families consider in selecting treatment for their child with type B ulnar polydactyly. METHODS We reviewed treatment outcomes and administered a survey by telephone to parents of children with type B ulnar polydactyly treated at a pediatric hospital between 2015 and 2020. We assessed satisfaction, reasons for choosing treatment, and post-management complications. RESULTS The families of 70 of the 156 consecutive treated patients were successfully contacted and agreed to participate (45% response rate). The mean follow-up was 27 months. Twenty-eight chose in-office suture ligation and 42 chose excision. Rapid treatment was prioritized by those who opted for in-office ligation (P = .044). The complication rate for suture ligation was significantly higher than excision (P < .0001), with the most common complication being a residual remnant (nubbin or neuroma stump) (64%). Respondents with residual remnant reported significantly less satisfaction with the appearance of their child's hand (P < .001) and with treatment outcomes (P = .028) compared to those without residual remnants. CONCLUSIONS Factors considered by parents in choosing type of treatment for type B ulnar polydactyly vary and may be significantly influenced by the surgeon. Although the majority of parents remain extremely satisfied with their child's outcome regardless of management type, time to treatment plays a determinative role in parents opting for ligation rather than excision in the operating room.
Collapse
|
2
|
Ashrafzadeh S, Fedeles F. What the rheumatologist needs to know about skin biopsy. Best Pract Res Clin Rheumatol 2023; 37:101838. [PMID: 37268560 DOI: 10.1016/j.berh.2023.101838] [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: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 06/04/2023]
Abstract
The skin biopsy plays an important and powerful role in helping diagnose rheumatic diseases that present with cutaneous findings. As the skin is a very accessible organ, and the skin biopsy can be performed quickly as an in-office procedure, the skin biopsy is utilized frequently in patients with rheumatic diseases. However, the more challenging aspects of performing the biopsy, such as identifying the type of biopsy to perform, the site (s) to biopsy, the type of media to use, and the interpretation of histopathologic data are nuanced and require considerable thought. In this review, we discuss the common skin findings in rheumatic diseases and the general indications for skin biopsies in these diseases. We then summarize how to perform various skin biopsy techniques and how to select the biopsy technique. Finally, we discuss important rheumatic disease-specific considerations for skin biopsy, including where to biopsy and how to interpret the pathologic reports.
Collapse
Affiliation(s)
- Sepideh Ashrafzadeh
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Flavia Fedeles
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
3
|
Sanders MH, Jain V, Malone M. Pediatric Office Procedures. Prim Care 2021; 48:707-728. [PMID: 34752279 DOI: 10.1016/j.pop.2021.07.010] [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] [Indexed: 11/20/2022]
Abstract
Pediatric patients are frequently evaluated in primary care clinics. Thus, there exists a need to understand common pediatric problems and to acquire a degree of familiarity with pediatric procedures. This article will review techniques and the current evidence for frequently performed pediatric procedures, including umbilical granuloma chemocautery, frenotomy, suture ligation of type B postaxial polydactyly, reduction of nursemaid's elbow, hair tourniquet removal, and tympanometry.
Collapse
Affiliation(s)
- Melanie H Sanders
- Department of Family Medicine, East Carolina University Brody School of Medicine, 101 Heart Drive, Mail Stop 654, Greenville, NC 27858, USA.
| | - Vasudha Jain
- Tidelands Health Family Medicine Residency Program, 4320 Holmestown Road, Myrtle Beach, SC 29588, USA
| | - Michael Malone
- Tidelands Health Family Medicine Residency Program, 4320 Holmestown Road, Myrtle Beach, SC 29588, USA
| |
Collapse
|
4
|
Schnabl SM, Ghoreschi FC, Scheu A, Kofler L, Häfner HM, Breuninger H. Use of local anesthetics with an epinephrine additive on fingers and penis - dogma and reality. J Dtsch Dermatol Ges 2021; 19:185-196. [PMID: 33586877 DOI: 10.1111/ddg.14434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022]
Abstract
Epinephrine supplements in local anesthetics are regularly used for surgery in areas with terminal vessels. According to the pharmaceutical guidelines, the use of epinephrine as an additive to local anesthetics is contraindicated for these areas. This review provides an overview of the current scientific data as well as new clinical developments in various fields. It also reviews the current legal situation. A literature research was carried out to survey the current status of relevant data. Written inquiries to several German institutions (Institute for Quality and Efficiency in Health Care, National Association of Statutory Health Insurance Physicians, Center for Clinical Studies Tübingen, Federal Institute for Drugs and Medical Devices) were made to determine the legal situation. No evidence was found in the literature for a causal relationship between the use of epinephrine as a vasoconstrictor and necrosis of the finger or penis. Studies and reviews show that the use of local anesthetics with epinephrine on the fingers or penis is a safe procedure with many clinical and economic advantages. In routine clinical practice, the WALANT method (Wide Awake Local Anesthesia No Tourniquet) as well as the increasing incidence of skin tumors in acral areas has led to a tendency towards increasing use. However, its use is still legally contraindicated, and the pharmaceutical companies show no interest in supporting a drug study. Further clinical trials - regardless of the strength of the evidence - would not change the current legal contraindication.
Collapse
Affiliation(s)
| | - Franziska Carola Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - University Medical Center Berlin, Berlin, Germany
| | | | - Lukas Kofler
- Department of Dermatology, University of Tübingen, Germany
| | | | | |
Collapse
|
5
|
Roerden A, Neunhoeffer F, Götz A, Häfner HM, Kofler L. Vorteile, Sicherheit und Nebenwirkungen der Tumeszenz‐Lokalanästhesie bei dermatologischen Operationen an Säuglingen. J Dtsch Dermatol Ges 2021; 19:352-358. [PMID: 33709604 DOI: 10.1111/ddg.14340_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/19/2020] [Indexed: 11/29/2022]
Abstract
Die Tumeszenz-Lokalanästhesie (TLA) spielt bei dermatochirurgischen Eingriffen eine wichtige Rolle. Die TLA bietet etliche Vorteile, wie lang anhaltende Betäubung, reduzierte Blutung während der Operation und Vermeidung möglicher Komplikationen einer Vollnarkose. Einfache Durchführung, günstiges Risikoprofil und breites Indikationsspektrum sind weitere Gründe dafür, dass TLA zunehmend auch bei Säuglingen eingesetzt wird. Es gibt nicht nur viele Indikationen für chirurgische Exzisionen im Säuglingsalter, wie angeborene Naevi, sondern es hat auch erhebliche Vorteile, wenn diese Exzisionen in einem frühen Alter durchgeführt werden. Dazu zählen die geringere Größe der Läsionen sowie die unproblematische Wundheilung und Geweberegeneration im Säuglingsalter. Dennoch müssen hinsichtlich der Anwendung der TLA bei Säuglingen einige Aspekte berücksichtigt werden, darunter die Dosierung, eine veränderte Plasmaproteinbindung und die Notwendigkeit einer adäquaten und lang anhaltenden Schmerzkontrolle.
Collapse
Affiliation(s)
- Alisa Roerden
- Department of Dermatology, University Hospital Tübingen, Germany, (Hautklinik, Universitätsklinikum Tübingen, Deutschland)
| | - Felix Neunhoeffer
- Department of Pediatrics, University Hospital Tübingen, Germany, (Klinik für Kinderheilkunde, Universitätsklinikum Tübingen, Deutschland)
| | - Angelika Götz
- Department of Anesthesiology, University Hospital Tübingen, Germany, (Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Deutschland)
| | - Hans-Martin Häfner
- Department of Dermatology, University Hospital Tübingen, Germany, (Hautklinik, Universitätsklinikum Tübingen, Deutschland)
| | - Lukas Kofler
- Department of Dermatology, University Hospital Tübingen, Germany, (Hautklinik, Universitätsklinikum Tübingen, Deutschland).,Center of Rare Skin Diseases, University Hospital Tübingen, Germany, (Zentrum für seltene Hauterkrankungen, Universitätsklinikum Tübingen, Deutschland)
| |
Collapse
|
6
|
Schnabl SM, Ghoreschi FC, Scheu A, Kofler L, Häfner HM, Breuninger H. Verwendung von Lokalanästhetika mit Adrenalinzusatz an den Fingern und am Penis – Dogma und Realität. J Dtsch Dermatol Ges 2021; 19:185-196. [PMID: 33586882 DOI: 10.1111/ddg.14434_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/31/2020] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - Alexander Scheu
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität, Tübingen
| | - Lukas Kofler
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität, Tübingen
| | | | - Helmut Breuninger
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität, Tübingen
| |
Collapse
|
7
|
Roerden A, Neunhoeffer F, Götz A, Häfner HM, Kofler L. Benefits, safety and side effects of tumescent local anesthesia in dermatologic surgery in infants. J Dtsch Dermatol Ges 2021; 19:352-357. [PMID: 33576159 DOI: 10.1111/ddg.14340] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/19/2020] [Indexed: 01/31/2023]
Abstract
Tumescent local anesthesia (TLA) plays an important role in dermatosurgical procedures. TLA has several benefits such as long-lasting anesthesia, reduced bleeding during surgery and the avoidance of general anesthesia-associated complications. Convenience and a favorable risk profile along with a broad spectrum of indications are further reasons why TLA is increasingly applied in infants as well. There are not only a variety of indications for surgical excisions in infancy, such as congenital nevi, but also substantial benefits when performing these excisions at an early age. These include the smaller size of the lesions as well as the unproblematic wound healing and tissue regeneration in infancy. Nevertheless, several aspects need to be considered when applying TLA in infants including dosing, altered plasma protein binding and the need for adequate and long-lasting pain control.
Collapse
Affiliation(s)
- Alisa Roerden
- Department of Dermatology, University Hospital Tübingen, Germany
| | | | - Angelika Götz
- Department of Anesthesiology, University Hospital Tübingen, Germany
| | | | - Lukas Kofler
- Department of Dermatology, University Hospital Tübingen, Germany.,Center of Rare Skin Diseases, University Hospital Tübingen, Germany
| |
Collapse
|
8
|
Abstract
Pediatric fingertip injuries are common and peak at 2 years of age. These injuries most frequently result from a crush mechanism and half sustain an associated fracture. The presence of a physis results in unique injury patterns and management considerations in the growing child. Due to a substantial healing potential in children, an initial conservative approach to management for many soft tissue and nail bed injuries is recommended. This article reviews the evidence and approach for treating pediatric fingertip injuries and amputations.
Collapse
Affiliation(s)
- Scott N Loewenstein
- Division of Plastic Surgery, Integrated Plastic Surgery Residency Program, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall, Suite 232, Indianapolis, IN 46202, USA
| | - Joshua M Adkinson
- Division of Plastic Surgery, Sidney and Lois S. Eskenazi Hospital, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall, Suite 232, Indianapolis, IN 46202, USA.
| |
Collapse
|
9
|
Aljahany MS, Aleid DK, Aal Ibrahim AM. Reversal of Digital Ischemia with Phentolamine After Accidental Epinephrine Injection. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923877. [PMID: 32921785 PMCID: PMC7518644 DOI: 10.12659/ajcr.923877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Accidental finger-stick injuries have been reported with epinephrine autoinjectors, such as EpiPen and EpiPen Jr, and can result in necrosis and digital ischemia. However, long-term adverse effects are very rare. The treatment for accidental finger-stick injuries is controversial and includes intra-arterial injections of vasodilating agents, topical vasodilators, and supportive management as needed. CASE REPORT Here, we report a case of a 26-year-old pharmacist who injected herself accidentally with an EpiPen on the tip of her index finger. Warm water and nitroglycerine gel did not alleviate her symptoms. After three hours, phentolamine was injected around the necrotic area, and the skin normalized. CONCLUSIONS All health professionals should be trained in how to handle epinephrine autoinjectors safely. Phentolamine may be efficacious in treating accidental finger-stick injuries from epinephrine autoinjectors.
Collapse
Affiliation(s)
- Muna Saleem Aljahany
- Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Dalal Khalid Aleid
- Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | | |
Collapse
|
10
|
Monahan JJ, Mantilla-Rivas E. Local Anesthetics With Dilute Epinephrine in Extremity Surgery, Including New Evidence for Pediatric Population. AORN J 2019; 110:438-442. [PMID: 31560433 DOI: 10.1002/aorn.12825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|